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Acta Scientific Otolaryngology

ISSN(p): | ISSN(e):2582-5550
Journal Papers (240) Details
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Indexed Journal

1 Emerging Trends and Recent Advances in Microvascular Anastomosis in Reconstructive Surgery , Deepthi Shetty.
Ablative procedures in head and neck region requires compos-ite removal of tissues during excision. This results in compromise of both functional activities and aesthetic mutilation. Reconstruc-tion of major extirpative defects is an extremely challenging task [1].During the last three decades there has been tremendous progress in the field of reconstructive surgery particularly with the advent of micro vascular free tissue flaps [2]. The transfer of vascularised free tissue is a cornerstone of modern reconstructive surgery which has improved the quality of life in many patients [3].
2 Comprehensive Role of Otorhinolaryngologists in the Management of Headache: A Prospective Tertiary Care Centre Based Study , Rajwant Kaur; Pawan Kumar.
Headache is most common complaint of human being. Classified into primary (migraine, tension headache and tri-geminal neuralgia) and secondary (infectious, vascular and drug induced). Sinugenic headache is deep seated, dull aching with full-ness and heaviness in sinus area. The purpose of study to assess the comprehensive role of otorhinolaryngologists in the diagnosis of headache and to evaluate the efficacy of medical and surgical management of patients presented with headache. 200 patients reported to rhinology clinic with headache. Detailed history, head and neck examination routine blood investigation, fundus examina-tion and anterior rhinoscopy, radiological investigations X-ray paranasal sinuses, skull and cervical spine and direct nasal endoscopy was and CT paranasal sinus preoperatively done
3 Congenital Bilateral Abductor Cord Palsy with Tracheomalacia: A Case in Neonate Managed Conservatively , Mayank Jain; Priya Jain; Shailabh Gupta; AP Mehta;Poonam Sidana.
Congenital stridor due to bilateral abductor cord palsy is rare. Congenital stridor due to laryngomalacia is the most common cause. Congenital abductor cord palsy (ACP) is the second most common cause. Vocal cord palsy (VCP) can be either congenital or acquired. It can be either unilateral or bilateral. Most common cause of abductor cord palsy is idiopathic. Congenital CNS anomaly like Arnold Chiari malformation is the most common cause resulting in B/L ACP. Here we report a case of congenital b/l abductor cord palsy presenting with tracheomalacia
4 Periorbital and Nasal Solitary Fibrous Tumor , Casas Ocando Julio J.
The nasal solitary fibrous tumor is an infrequent benign unilateral tumor, were originally first described as a rare mesenchymal neoplasm that commonly involves the pleura, originating from spindle cells, described in 1931 by Klemperer and Rabin. It is further sub-classified as a benign type of mesothelial tumor; it has been reported in other regions such as: the orbit, nasopharynx, thyroid gland, parapharyngeal space, tongue, major salivary glands, lung, mediastinum, extremities, the liver also rarely affect the nasal cavity and paranasal sinus.The diagnosis is primarily histological, it consists in a positive immunohistochemical finding of CD34.Author report a case of 36 years-old man presented with a 3-month history of persistent progressive left nasal bleeding, left nose obstruction and left eye pain is reported. Physical assessment and nasal endoscopy revealed a pain small rubbery mass palpable in the superonasal quadrant of the left eye and the tumor arose from the left ethmoid sinus and extended to the left nasal cavity and the periorbital area. Further imaging by CT and MRI disclosed a large left-sided nasal and periorbital cavity homogeneous mass, occupying left maxillary sinus, left ethmoid, extending to the left frontal sinus and left orbit. The tumor successfully was removed by endoscopy sinus surgery without complication. The tumor had spindle-shaped cells and was positive for CD34, CD99, Bcl-2 and desmin, histopathological analysis of the specimen was consistent with nasal solitary fibrous tumor. This paper describes the presentation, diagnosis, and treatment of a male patient with a Periorbital and Nasal Solitary Fibrous Tumor.
5 Concomitant Synspondylism and Thoracic Spinal Meningioma, An Extremely Unusual Occurrence , Akshay Agarwal;Utkarsh Mishra.
Lower back pain is an extremely common and rather vague entity with numerous differentials in its list ranging from congenital to non-neoplastic and malignant lesions. Here, we report a rather unusual cause of back pain resulting from congenital and neoplastic etiology. Synspondylism, which is fusion of the thoracic vertebrae and an intradural extramedullary meningioma of suspicious inva-sive pattern of growth in the same patient is discussed along with a brief review of literature.
6 Universities Support for Professors and Students during Covid-19 , Mahdieh Motie;Reza Dehnavieh;Zahra Sarabandi;Sepideh Bani Asad;Khalil Kalavani.
The onset of Covid-19 around the world shut down face-to-face education in schools and universities. Thus, the Coronavirus pandemic replaced face-to-face education with virtual education. Therefore, universities must have necessary infrastructures for e-learning, such as the development of the World Wide Web and accelerating it as well as the capacity to produce educational soft-ware [1]. However, some students may not have access to required facilities for e-learning and may even be affected by the pandemic. So, they need to be supported by the universities [2,3]
7 Bleomycin Sclerotherapy Following Doxycycline Lavage in the Treatment of Ranulas: A Retrospective Analysis and Review of the Literature , Manna Sayan.
A ranula is a mucus-filled salivary pseudocyst that forms in the floor of the mouth, commonly arising from the sublingual or submandibular salivary glands following obstruction or trauma. Complete excision of the injured gland and removal of the cyst content is first-choice therapy, but has the potential for complications related to injury to nearby structures. As such, minimally inva-sive approaches such as percutaneous sclerotherapy have been investigated. We aim to contribute to the literature by assessing the efficacy and safety of our technique through our experience with 18 patients over the last decade.
8 Determining the Relation between PET/CT and Staging in Larynx Carcinoma , DoÄŸan Çakan; Muhammet Gazi Yildiz.
The purpose of this study is to determine the relation between the positron emission tomography/computed tomography (PET/CT) findings and post-operative pathology findings, which is a guiding characteristic for staging in patients with larynx cancer.
9 Kinetic Oscillation Stimulation of Nasal Mucosa as Treatment for Non-allergic Rhinitis. A Pilot Study , Nacie Bello Petersen and Knud Larsen
Introduction:Patients with persistent symptoms for non-allergic rhinitis (NAR) often relay on medical treatment and/or surgical approach. Kinetic oscillation stimulation (KOS) seemed in a few studies to have a positive effect and reduces symptoms for NAR. This pilot study aims to demonstrate effect of KOS in objective and subjective assessment in Danish patients. Method: Fifteen patients with NAR were included and values for nasal inspiratory peak flow (NIPF) , subjective score using SNOT22 and VAS score for pain and patients allover judgement were registered. KOS treatment was offered two times with two weeks interval.Results: Significant change of SNOT22 and NPIF was only present after two treatments. From patients allover judgement there were nine who felt improvement or satisfied but one of these also wanted minor surgery giving a success rate of 53%. The treatment wasaccepted of all patients with no pain but with minor or moderate discomfort.Conclusion:Kinetic Oscillation Stimulation , KOS, of nasal mucosa showed significant effect after second treatment when evaluating sino-nasal-outcome test ,SNOT22 and nasal inspiratory peak flow, NPIF. Patients tolerated the treatment without major discomfort and the patients all over judgement of effect was 53% and was regarded as satisfactory in this pilot study. The result seems to justify further research for which is giving some proposals.Keywords:Kinetic Oscillation Treatment; Non-allergic Rhinitis; Nasal Congestion; Clinical Trial
10 I’m Sorry! You may have to Endure the Oral and Facial Pain a Little Longer , Rasheed Ofosu-Poku.
Head and neck cancers (HNC) are one of the ten leading can-cers globally, and its incidence in Africa in general and Ghana in particular is increasing [1,2]. HNC are associated with profound mortality and morbidity. Pain in face, oral cavity and throat are among the most common presentations before treatment when the tumor is pressing on and invading local structures, during treatment due to severe oral mucositis and effect of radiotherapy on facial and trigeminal nerves and surrounding tissues, and after surgical treatment and chemoradiation due to persistent effect on nerves [3,4]. Patients therefore experience a combination of noci-ceptive and neuropathic pain chronically [5].
11 Overcoming Aphonia in Head and Neck Surgery Patients with VoRA , Delaney H Sheehan;Wayne J Wortmann;Leslie Son2 and Rohan R Walvekar.
Objectives:Our primary objective is to survey patients who have experienced postoperative aphonia after major head neck surgery to understand questions and phrases that were necessary for them to communicate with their healthcare provider. Our secondary objective is to create an application used on an Amazon Fire HD tablet that will allow aphonic patients to interface with their health-care providers.Methods: Survey study of patients in 2019 who had undergone a head or neck surgery resulting in aphonia and who were treated within the Department of Otolaryngology at Louisiana State University Health Sciences Center. Patient demographics and phrases for effective communication were recorded and analyzed. An application for Android Fire HD tablet was then developed using the survey results to vocalize the phrases.Results: Six patients who were surveyed were included. The causes for aphonia included laryngectomy (n = 4, 67%), squamous cell carcinoma excision (n = 1, 17%), and an unspecified vocal cord procedure (n = 1, 17%). The most commonly requested phrases were “pain medication” (n = 2, 33%) and “discharge date” (n = 2, 33%), followed by “food,” “restroom,” “thank you,” and terms to commu-nicate with friends and family. A prototype application was created for use on an Android Fire HD tablet with 12 phrases associated with image icons available in English and Spanish.Conclusions:Patient anxiety is heightened in the post-operative period when communication with providers is limited due to apho-nia. Technology-based solutions can help ameliorate this barrier to optimal patient care. Further studies will demonstrate the effec-tiveness of the application in the patient care setting.Keywords:Aphonia; Voice Restoration; Tracheostoma; Laryngectomy
12 Treatment of Sensorineural Hearing Loss in Children: Platelet Rich Plasma , Brajpal Singh Tyagi
Introduction:Hearing loss is one of the common disabilities in India. The prevalence of this disability is higher in children. The children with sensorineural hearing loss is very common which requires the safe, clinically effective and cost effective method of treatment. Methods:The platelet rich plasma (PRP) was instilled in 24 children od age less than 10 years and the hearing improvement was assessed by the audiogram through BERA or PTA. Results:It was found that 87% patients had bilateral impairment, and maximum patients were with moderate hearing impairment. The rate of improvement was found to be 99% except one patient who had no improvement in the left ear post PRP. Conclusion:In our study, the patients with moderate to profound sensorineural hearing loss were found to have improved hearing levels after treatment with PRP which directly enhanced their speech discrimination levels. Further studies with bigger sample size are needed to establish this method as new doorway for improving the childhood hearing.
13 Hanging Polyp: A Rare Entity in Oral Pathology , Sambhaji G Chintale;Vilas R Kirdak; Swati S Chintale;Kaleem A Shaikh;Sonali P Jatale.
The oral cavity is the first most important part of the gastrointestinal system. In which both types of pathology occurs that may be benign, which are more than malignant, which occurs more frequently in tobacco chewers, smokers, and alcoholic than a person who is non smokers and non-alcoholics. In the oral cavity where most of the diseases presented as the benign lesions may transform into malignancy that’s why any pathology in the oral cavity we have to be careful in handling such pathology. One such case of 45 yr old male smokers presents with difficulty in swallowing due to the enlarged oral hanging polyp for one year.
14 Posteriorly Expanded Supraclavicular Artery Flap Can Reach Distant More Reliable and Safe , Abdolreza Rouientan;Alireza Hoseini Sianaki;Hojjat Molae.
Introduction:Head and neck soft tissue reconstruction by supraclavicular flap is interesting, because of thinness and known ana-tomical landmarks. Distal ischemia and flap missing, evoked considerations to reinforce transferred flap in a reliable way. We tried by introducing expanded posterior supraclavicular flap.Patients and Methods: During 8 years, 11 patients with complex facial scars underwent facial skin defect reconstruction by inser-tion of rectangular tissue expander in a properly matched size in the subcutaneous pocket of posterior margin of ipsilateral supracla-vicular area in the first surgery and then removal of tissue expander and prepared flap transfer to resultant recipient defect. All early and delayed donor and recipient site complications analyzed.Results: 11 patients operated in sequential stages and removed scar defects reconstructed by flap. The mean size of involved area was (201.579 +/_ 24.73) cm2, and after about 3.27 months inserted tissue expanders were removed and flaps used to cover defects. The most significant donor site morbidity was mild hypertrophic scar which did not need operation and only one recipient site with wound dehiscence required secondary surgery.Discussion:Supraclavicular artery flap is used traditionally to cover head and neck soft tissue defects. Distant defects are challeng-ing for surgeons to save probable ischemic distal ends. Tissue expansion, especially in posterior part of supraclavicular, not only reinforces vasculature nourishment of flap and diminishes wound problem risks, but also makes flap thinner and more pliable to adjust defects.Conclusion:Supraclavicular artery flap` expansion on posterior area can help reach distally safer and reliable.
15 Telemedicine in Otolaryngology During COVID-19 Pandemic: Our Experience , Vikasdeep Gupta;Vaibhav Saini;Gagandeep Kaur and Ankur Mohan.
Objective:To study the feasibility and scope of telemedicine in otolaryngology in the COVID 19 pandemic and global lockdown.Methods: A retrospective study was performed in the otolaryngology department during COVID 19 pandemic at AIIMS Bathinda. Telemedicine consultation was set up to replace face to face consultation. Both audio and video consultation facility option was pro-vided to patients. The patient satisfaction survey was done to assess the satisfaction level of telemedicine during COVID 19 pandemic in otolaryngology patients. The patient had to register for audio or video consultation, after which the patient would receive a call from the concerned department on the next day on the allotted time. The time slot for each patient was 15 minutes. Consultations were performed by the senior otolaryngologist. The informed consent was taken from the patient. The study was approved by insti-tutional ethical committee.Results:The total of 95 patients enrolled for teleconsultation in the otolaryngology department during the period from April 2020 to August 2020. The most common age group range was 21-40 years. The male to female ratio was 1.2:1. Out of 95 patients, 58 patients had registered for audio teleconsultation and 37 patients for video teleconsultation. The most common subspeciality patients were throat and head and neck. The overall satisfaction rate was 89%.Conclusions:Telemedicine is useful for follow up patient and we can rely on telemedicine in these patients. It helped patients to reach health care specialist while reducing the exposure to both.
16 Primary Non Hodgkin’s Lymphoma of Glottis: A Diagnostic Dilemma , Shashikant Anil Pol;Aditi Mahajan;Reetu Kundu;Surinder K Singhal;Nitin Gupta.
Primary Non-Hodgkin’s lymphoma of the larynx is rare, accounting for less than 1% of all laryngeal neoplasms. Fewer than 100 cases have been reported in the literature. Early symptoms are nonspecific and subtle, so confirmation of the diagnosis is difficult thereby leading to a delay in management. We hereby present a case of a 30 year old male with Non Hodgkin’s lymphoma of larynx who presented with hoarseness as the only complaint. In this case, intra operative assessment and histological interpretation was critical, and formed the basis of correct management in the form of radiotherapy
17 Comparison of Envelope Perception between Syllabic and Dual Compression Hearing Aid Processed Kannada Chimeric Sentences , Devi Neelamegarajan1;Sridhar Sampath;Vinayagar PT.
Introduction:Temporal envelope cues and temporal fine structure cues are essential for perception of speech. However, tonal lan-guage employ more of TFS cues and non-tonal language employ envelope cues for perception. The native speakers of Kannada use envelope cues for speech perception. Perception might vary depending on the compression characteristics and the number of pro-cessing channels in hearing aid users. So, it is important to understand the effect of compression system and processing channels on perception of envelope cues. Objective: To compare the perception of envelope cues: across different frequency bands; between syllabic and dual compression, between an eight channel and sixteen channel hearing aids, using hearing aid processed Kannada chimeric sentences.Methods and Materials: Sentence identification task was carried out in thirty native adult Kannada speakers with normal hearing acuity. Stimuli used was hearing aid processed Kannada chimeric sentences prepared with standardised sentence identification test in the Kannada language through Hilbert transformation and processed using 2 hearing aids of eight and sixteen processing channels in syllabic and dual compression programs.Results:Perception of envelope cues were not significantly different using chimeric sentences processed using syllabic and dual compression system, where as it was significantly different while using chimeric sentence processed using 8 and 16 channel hearing aids.Conclusions:Dynamic characteristics of compression system such as fast and slow acting have no effect on perception of envelope cues in native Kannada speakers, whereas number of signal processing channels need to be considered while evaluating the percep-tion of envelope cues.
18 Post-infectious Lymphedema Can Cause Facial Paralysis , Salvatore Bühling.
Background: Lymphedema (LE) as well as facial palsy ́s (FP) are relatively common disease.FP can be divided into idiopathic FP (Bell ́s palsy) and secondary FP due to a determined reason like trauma. The most common reasons of secondary FP are metabolic disease, tumors, infections, neurological disorders, autoimmune disorders, trauma and surgi-cal interventions.LE is a high protein edema. The most common reasons for a secondary LE are lymphatic filariasis, irradiation and surgical inter-ventions.Report: A 51 year old male with uncontrolled diabetes mellitus and a hypersensitivity lung disease (HLD) presented with 3 days fever and cellulitis in his face. He developed a very extensive LE and becomes septic (in the cours, he needs pressors and intubation for airway protection). The rapid streptococcal test was positive.In the examination, we diagnosed then a dense, painless facial nerve palsy in all branches on the left (except his marginal branch).Conclusion: In our knowledge, this is the first publication which reports, that a LE causes a secondary FP. Due to the fact, that both LE and FP are not so rarely seen disorders, our goal is to sensitise other physicians about the possibility of a casual coherence between them; that may be of important relevance for the outcome of the patients.
19 COVID 19 Pandemic: A New Burden on Communication in Elderly , Somia Tawfik Mohamed Ali;Noura Essam Eldin Ammar.
The ongoing pandemic of coronavirus disease 2019 (COV-ID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is undoubtedly the defining global health crisis and the greatest challenge the world has faced since the World War II. . Actually, this serious health problem mandates lockdown and certain protective measures. These includes social distancing, self-isolation measures as well as use of facemasks. All these measures have negative impact on communication. For example, wearing Facemasks can hinder proper communication as the sounds be-come muffled. However, it is considered one of the most protec-tive measures as it guards against infection and keeps people safe. More than 50 countries mandate wearing masks in public.
20 Smartphone Apps for Hearing Surveillance During the COVID Pandemic , Yahya Ghaffar;Gauri Mankekar.
Telemedicine has become the preferred modality for providing healthcare during the COVID -19 pandemic. It has helped connect patients safely with their physicians to monitor their health. Telemedicine has its challenges. Technology, creativity and resourceful-ness is assisting to overcome them. Amongst Otorhinolaryngological specialties, treating Otology issues via telemedicine has been traditionally difficult. Here we discuss our experience incorporating Smartphone apps and video otoscopes in Otology telemedicine during the COVID pandemic.
21 Glomus Jugulare - A Rare Presentation , Siddam Revathi; L Sudarshan Reddy; M Mohan Reddy.
A case report on glomus jugulare from India.We present a case of a 15-year-old male, with 6 months history of tinnitus and progressive hearing loss, presented with facial nerve palsy (House-Brackmann V). Computed tomography scans demonstrated an enhancing soft tissue lesion with erosion of jugu-lar bulb, invasion of the petrous and tympanic bone, middle ear and vertical part of facial nerve with erosion of postero medial wall of left TM joint (type C2 of Fisch’s classification for GJT). Intraoperatively the mastoid part of the facial nerve was identified involved by tumour and needed to be resected. Inter positioning cable grafting with greater auricular nerve, harvested at the beginning of the surgery is done. Total tumour resection is done with a remarkable postoperative course. The patient also presented with improve-ment in facial nerve function after 6 months. The patient consented with publication of his images.
22 New Wave of Covid-19: Reinfection and Immunization , Luciana de Barros Correia Fontes; Maria da Conceição de Barros Correia;Kátia Maria Gonçalves Marques;Nayara Ferreira da Silva1, Marília Cleide Tenório Gomes;Amanda Caroline Oliveira Henriques Mendes;Rosa Maria Mariz de Melo Sales Marmhoud Coury;Denise Nóbrega Diniz;Criseuda Maria Benício Barros;Leonardo Bezerra Cavalcanti dos Santos;Niedje Siqueira de Lima.
This opinion is based on the experience in teleconsultancy of Covid-19, from the month of March until the present, in December of the year 2020. The world highlights the "new wave" of the pandemic caused by SARS-CoV-2 and, at the same time, there are reports of reinfection. With immunization processes being investigated and set in motion, many doubts and questions occur in this period of coexistence; some of those raised here
23 Knowledge on Cochlear Implants among Medical Students, Tanzania , Massawe Richard Enica1;Ntunaguzi Daudi;Ibrahim Abdul Hazali.
Background: Cochlear implantation is one of the most performed surgery worldwide currently to people mostly children with sensorineural hearing loss to solve the effects of severe to profound hearing loss and without this, these children would be left with deafness for life. Tanzania has also developed and started to perform cochlear implantation to children in 2017. Objective: The main aim of this study was to assess Knowledge on cochlear Implants among senior medical students and interns who are going to be the primary care providers and will be required to make proper diagnosis and referrals for children requiring cochlear implants to the right facilities for further management hence their knowledge is of great essence.Methodology: Descriptive cross sectional study was used, a structured questionnaire was used to collect data and Stratified random sampling method was used to get participants. Self-administered questionnaires was used for data collection and collected data was coded and analysed using IBM SPSS version 24.0.Results: In this study which involved 203 participants, we found that only 87.2% have ever heard about cochlear implants and only 80.2% knew that cochlear implants may restore hearing to the deaf and 11.3% did not know that children who received cochlear im-plant could learn spoken language also 35% of the participants did not know that cochlear implant is being done in Tanzania despite starting performing the surgery since 2017. More than half of the participants are knowledgeable to different candidacy criteria for cochlear implantation however only 23.2% of the participants knew that a child without a cochlear is not a candidate for cochlear implants. More than 90% of participants knew that Audiologist, Otolaryngologist and speech therapist are key members of cochlear implant team but only 65% knew that a social worker is also a member of the team. We also found that more than half of the partici-pants knew that infections, device failures, cerebral spinal fluid fistulas facial nerve paresis and cholesteatomas are complications associated with cochlear implantations. It was also found that there was an association between the university studied/studying and the level of knowledge, Majority of government owned university students having high knowledge while those of private owned having moderate knowledge.
24 Middle Ear Effusion in Preschool Children in Dar-es-Salaam, Tanzania , Enica Richard Massawe; Daudi Cheche Ntunaguzi;Ndeserua Moshi and Kassim Babu Mapondella.
Background: Otitis media with effusion is a common disorder in children, which may either resolve spontaneously or cause undesir-able complications especially if associated with persistent hearing loss.Otitis media with effusion contributes to hearing loss, poor speech acquisition and learning difficulties. There has not been any retrievable study done to show the magnitude of otitis media with effusion and its complication in our country.Aim: This study aimed at determining the prevalence of otitis media with effusion among preschool children in Kinondoni District, Dar es Salaam.Materials and Methods: This study was conducted in Kinondoni District, Dar es Salaam in Tanzania among 541 preschool children aged 2 to 6 years. Random sampling method was used. Otoscopic examination was done by the principal investigator using pneu-matic otoscope. Diagnosis of otitis media with effusion was reached by findings of the ear drum with exclusion of features of acute otitis media. Tympanometry was conducted by research assistant and type B curve was regarded as diagnostic for otitis media with effusion.EPI-INFO version 6.04d computer program was used to analyze the data and relationships were tested at 5% tolerable error.Results: Out of 541 preschool children screened, 24% had otitis media with effusion in one or both ears. Fifteen percent had bilat-eral otitis media with effusion while 4.8% had right and 4.3% had left otitis media with effusion respectively. Of the screened female children, 26.5% had otitis media with effusion which was slightly higher than males (21.7%). The prevalence of otitis media with effusion was higher (24.5%) among children aged 5 to 6 years as compared to prevalence of 22.5% among children aged 2-4 years. Both pneumatic otoscopy and tympanometry detected otitis media with effusion in 17.8% of children aged 2 to 4 years while 14.3% of children aged 5 to 6 years were detected by pneumatic otoscopy and 14.1% were detected by tympanometry.The pneumatic otoscopy was found to be as good as tympanometry in diagnosing otitis media with effusion and it’s sensitivity was found to be 97.7% and specificity was 99.5%.Conclusion: The overall prevalence of otitis media with effusion among preschool children in Kinondoni District in Dar es Salaam was noted to be high. The prevalence was higher among children aged 5 to 6 years and in females. Pneumatic otoscopy was as good as tympanometry in diagnosing otitis media with effusion.
25 The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients , Siti Nurfarhana Mohd Arif;Mawaddah Azman;Sharifa Ezat Wan Puteh; Nur Shahrina Mohd Zawawi;Abdullah Sani1 and Marina Mat Baki.
Objectives:1) to evaluate the reliability of measurements of maximum vocal intensity (maxVI), reading pitch range (RPR) and sing-ing pitch range (SPR); 2) to determine the parameters’ correlation with voice handicap index-10 (VHI-10); and 3) to compare the difference of the parameters between pathology and healthy group.Methods: This cross-sectional studythat was performed in a tertiary centre included 30 patients diagnosed with unilateral vocal fold palsy (UVFP) and 30 healthy volunteers (n = 60 participants). The participants’ voices were measured for maxVI (dB) using Sound Level Meter (SLM) at 100cm, and RPR and SPR (Hertz) using OperaVOX at 30cm distance, from lips. The phonation tasks were vowel /a/ at maximum loudness (maxVI), reading a standard passage (RPR) and glissando mode /a/ (SPR). The measurements were re-peated within 30 minutes interval. Voice handicap index-10 (VHI-10) was documented for all participants. The internal consistency of the measurements was evaluated using intraclass correlation (ICC). Correlation of parameters with VHI-10 was assessed with Spearman Correlation Coefficient. The comparison between two groups was done with Mann Whitney U Test. Results: The reliability of maxVI, RPR and SPR was substantial to excellent with ICC of 0.83 (0.7,0.89), 0.9 (0.94,0.97) and 0.62 (0.44, 0.61) respectively. There was a significant difference for maxVI and SPR between the UVFP and healthy volunteers (p < 0.01). MaxVI showed good significant negative correlation with VHI-10 (r -0.63, p < 0.05) whereas RPR and SPR were poorly correlated with VHI-10 (r = -0.126 and r = -0.28, p > 0.05). Conclusions: MaxVI showed good results depicted by its excellent reliability, ability to differentiate between UVFP and healthy volunteers and good correlation with VHI-10. Thus, MaxVI is may be a potential primary outcome measure in future clinical trials related to UVFP.
26 Primary Ciliary Dyskinesia with Structurally Normal Cilia: An Unusual Diagnosis , Hugo Marcos;Tiago Soares Santos;Paulo Gonçalves;Mário Sousab;Elsa Oliveira; Carlos Carvalho;Mikkel Christian Alanin.
Defects in cilia are associated with several human diseases. Chronic rhinosinusitis with nasal polyps is one of those diseases. Ultrastructural ciliary defects diagnosed by transmission electron microscopy are usually seen. Rarely are found patients who have structurally normal cilia with an abnormal ciliary function. We present 2 cases of 15-year-old and 13-year-old female patients with chronic rhinosinusitis with nasal polyps and primary ciliary dyskinesia with structurally normal cilia. Although they had structurally normal cilia at transmission electron microscopy, when analyzed for variation in ciliary beat axis and ciliary deviation, the results were compatible with primary ciliary dyskinesia
27 Lipoma of Tongue: A Common Lesion at an Uncommon Location , Sanika Kulkarni, Dinshaw Hormuzadi2, Jaydeep Pol, Himanshu Soni and Shivani S Desai
Though lipoma is a most common benign tumour its incidence in oral cavity is very rare. These lesions are usually slow growing and painless hence go unnoticed for years. Because of the rarity of this tumour, here we are discussing a case of very large and long standing lipoma of tongue and its surgical management.Keywords: Lingual Lipoma; Intraoral Lipoma; Wide Excision; Tongue Lipoma
28 Changes in the Color and Sensitivity of the Tongue in Adult Women After COVID-19 Treatment , Luciana de Barros Correia Fontes, Maria da Conceição de Barros Cor-reia, Kátia Maria Gonçalves Marques, Pedro Henrique Bezerra Fontes, Nayara Ferreira da Silva, Marília Cleide Tenório Gomes, Rita de Cássia Barreto Fernandes, Daniele Andrade da Cunha, Hilton Justino da Silva, Leonardo Bezerra Cavalcanti dos Santos and Niedje Siqueira de Lima
Objectives: to describe the changes in color and sensitivity of the tongue in adult women, in the period after the treatment of COVID-19 and explain the dental conduct for treatment. Case report: there was a request for dental evaluation by a public and re-ference University Hospital in the city of Recife, northeast of Brazil. The patient in question was a 33 years-old white female. There was a history of diagnosis and treatment for COVID-19, with antibiotic, antipyretic and medication for worms, with the complaint of much sensitivity and change in language. The physical examination showed gingivitis in the lower sextant, with spontaneous gingival bleeding and dark spots on the dorsum of the tongue, associated with increased discomfort in the region. It was observed that the patient did not receive any orientation about oral hygiene, even with the report of pain in this region. It was opted for the orientation of the hygienization, with the reinforcement of the cleanness of the tongue, cheeks with hydrogen peroxide or oxygenated water to 10 volumes and the reinforcement for the ingestion of vitamin C, beyond the control of the biofilm, for the treatment of the gingivitis in the anterior and inferior sextant. Conclusions: this report covers the control made in seven days, being the images referring to the third day after the guidelines. There was a change in the color of the tongue and sensibility, with regular ingestion of food and liquids. There was also an improvement in gingivitis, but control is necessary.Keywords: Oral Health; Tongue; Coronavirus Infection
29 The Mephitic Vascularity-Bacillary Angiomatosis , Anubha Bajaj
Bacillary angiomatosis is an uncommon, reactive vascular pro-liferation additionally denominated as “epithelioid angiomatosis”, engendered by miniature, gram- negative bacilli of Bartonella ge-nus especially Bartonella henselae and Bartonella quintana. Bacillary angiomatosis was initially scripted by Stoler., et al. in 1983 as an “atypical, subcutaneous infection associated with au-toimmune deficiency syndrome (AIDS)” [1]. The condition com-monly appears in subjects infected with human immune deficiency virus (HIV) although immunocompromised, non HIV infected or immune competent individuals are also incriminated
30 CSOM with Sclerotic Mastoids: Does Cortical Mastoidectomy Offer any Benefit Vis a Vis Graft Uptake and/or Hearing Outcome , Tsewang Thinles, Shahid Rasool, Alyuza Saman, Ratna Priya
Background: Chronic suppurative otitis media (CSOM) without cholesteatoma is a common diagnosis in otologic practice. Although opinions vary regarding the definition of chronic otitis media, most consider middle ear disease to be chronic if present for longer than 6 weeks. In cases of an actively discharging ear, it has been shown that mastoid exenteration frequently, but not always results in disease resolution. In quiescent chronic otitis media studies have shown that good outcomes are possible, irrespective of whether mastoidectomy was added to tympanoplasty or not.Objectives: Does mastoidectomy improves hearing and/or graft uptake rates in CSOM with sclerotic mastoids.Procedure: This is a prospective comparative study were patients with safe type of CSOM with dry ear for 1 month and having ra-diological evidence of mastoid sclerosis were included. Patients were divided randomly into two Group A and B with 32 and 40 cases respectively. Group A Patients underwent type 1 tympanoplasty with cortical mastoidectomy. While as Group B patients were offered standard type 1 tympanoplasty only.Results: The observations with respect to post-operative graft uptake rates in two groups under comparative study were quite simi-lar and comparable with p value of 0.873. Although the graft uptake rate in group A (84%) was seen on higher side compared to that in group B (80%). There was significant improvement in post-operative AB Gap in both groups with p value of < 0.0001. Moreover, no significant statistical difference was noted in post-operative AB Gap between the two groups at an average follow up period of 6 1/2 months. Conclusion: We concluded that mastoidectomy hardly offers any additional benefit with respect to graft uptake and hearing im-prove ment in sclerotic mastoids. So, the author doesn’t recommend the routine addition of mastoidectomy for sclerotic mastoid unless there are other compelling indications.Keywords: Sclerotic Mastoid; CSOM; Tympanoplasty; Cortical Mastoidectomy
31 Slight Improvement of Symptoms in a Patient with Otosclerosis by Occlusal Modification: A Case Report , Kengo Torii
The relationship between some aural symptoms and dental occlusion have been reported, However, the relationship between oto-sclerosis and occlusion has not yet been reported. Occlusal improvement was achieved using the occlusal position correcting therapy on a patient with otosclerosis. Occlusal analysis was performed by mounting dental models on an articulator and identifying a pre-mature occlusal contact on the right second molar artificial teeth and a deviation of the habitual occlusal position from the muscular occlusal position. Occlusal modification was performed to make the habitual occlusal position coincide with the muscular contact position. The persistent tinnitus on the right ear became intermittent. From time to time, the ringing sound of the bell appeared. And the hearing impairment on the right ear was not improved.Keywords: Habitual Occlusal Position; Muscular Occlusal Position; Otosclerosis; Tinnitus
32 Foreign Body in the External Auditory Canal. Case Report , Mahomed Sidique Abdul Cadar Dadá, Abdul Habib Mahomed Dadá2
Foreign bodies in the natural orifices of the head and neck is a frequent problem observed in otorhinolaryngology consultations and emergency services at hospitals and private clinics. Foreign bodies are introduced intentionally or accidentally. In the present clinical case, we discuss the story of a 5-year-old child who introduced bicycle spoke nipple in to the ear. Extraction was performed by washing, without any complications.It is a rare and unusual object. Hence the importance of taking into account all objects existing in the home that can potentially become foreign bodies, especially if there is a car or bicycle repair site in the house. Never leave small objects accessible to children. Always bear in mind that any object, however small, deserves the child's curiosity and potentially will end up in one of the head and neck holes.Keywords: Foreign Body; External Auditory Canal; Ear
33 Tongue Lipoma: Rare Location for a Tumor , Casas Ocando Julio J
Epithelial tumors have predominance in the tongue but it is an uncommon location for lipoma, tumor of mesenchymal origin, be-nign, asymptomatic slow-growing, soft tissue neoplasm of mature adipocytes, that can be sessile or pediculated, single or lobed and surrounded by a thin fibrous capsule [1,2], rarely recurs after sur-gical treatment [2,3].
34 Supervision of Hospitals and Healthcare Centers during COVID-19 , Mahdieh Motie,  Reza Dehnavieh, Khalil Kalavani
COVID-19 pandemic is a major challenge affecting the health systems of all countries in the world and health workers are strug-gling with the virus for a long time and are providing health ser-vices every day. Although they may feel tired and worn out, hospi-tals and health care organizations around the world are doing their best to support the front-line forces. Due to the corona pandemic, there is excessive work pressure on health workers, and managers must take appropriate measures to support them in various ways
35 Utility of Ultrasound and Colour Doppler in Evaluation of Pediatric Vascular Lesions in the Neck , Rajesh C Kamble, Alpana N Joshi, Pravin Mestry
Vascular lesion is an all-encompassing term used to describe a wide range of conditions consisting of an abnormal number, struc-ture, or position of blood vessels. Keywords: Ultrasound; Vascular Lesions in Neck; Pediatric Vascular Neck Pathologies
36 Impact of Systemic Arterial Hypertension on Cochlear Function , José Luis Treviño-González, Germán A Soto-Galindo, Félix Maldonado-Chapa
Background: Systemic arterial hypertension is a highly prevalent disease that has been associated with cochlear impairment. Aims: The purpose of our study is to evaluate hearing thresholds and to identify the presence of tinnitus and its severity in patients with hypertension and compare them with a healthy control group.Methods: A cross-sectional and comparative study was performed, comparing 131 patients with hypertension to 331 healthy con-trols. Subjects underwent pure tone audiometry to evaluate hearing thresholds for low, mid, and high frequencies and speech audi-ometry. All subjects were evaluated for the presence of tinnitus. Tinnitus handicap index was completed to determine the severity and impact of tinnitus on quality of life. Results: In the hypertension group mean hearing thresholds in low frequencies were 18.8 dB (± 8.06), 21.2 dB (± 9.72) in mid fre-quencies, and 35.9 dB (± 17.42) in high frequencies; for which a significant statistical increase was shown in low frequencies (p = 0.0001), mid frequencies (p = 0.0003), and high frequencies (p = 0.0001) compared with the control group. A significant difference (p = 0.0001) was found in the prevalence of tinnitus of hypertension patients (80%) compared with control subjects (17%). We observed a mean score 15.98 (± 17.67) in the tinnitus handicap index of patients with hypertension showing a significant difference compared to a mean score 4.55 (± 1.51) in the control group (p = 0.001). Conclusion: A significant increase in hearing thresholds, prevalence, and severity of tinnitus in patients with hypertension was shown compared to a healthy control group. This study consolidates an association between systemic arterial hypertension and cochlear impairment.Keywords: Systemic Arterial Hypertension; Hearing Loss; Tinnitus; Audiometry
37 Unknown Mystery of Microchimerism , Osman Demirhan, Bülent Demirbek
Chimera is defined as a monsterous made up of parts of multiple animals in mythology. Today, the term chimera is used in the fields of genetics and molecular biology to describe living entities that emerge or are created as mixtures of separate entities. There-fore, microchimerism (Mc) is defined by the presence in an individual of a small number of cells or DNA belonging to a genetically dif-ferent individual. Pregnancy is the most common and natural cause of chimerism and occurs by the bi-directional passage of hemato-poietic cells through the placenta between mother and fetus. Bidirectional cell exchange between pregnant woman and fetus during pregnancy potentially leads to microchimerism (Mc) in both the mother and the fetus. Therefore, we are all born as microchimeric.Keywords: Microchimerism; Fetal-Maternal Microchimeric Cells; Autoimmune Diseases; Viral Disease; Canser; Jung-Archetypal
38 A Rare Case of Cowden Syndrome Presenting as Multinodular Goitre , Hari Shankar Sharma, Shivali Sharma
Screening for cancer associated with syndromes is a very common practice nowadays. Nodular Thyroid disease is very uncommon in childhood and adolescence when their family is having history of nodular thyroid disease which has been diagnosed with benign or malignant disease. Keywords: Cowden Syndrome; Thyroid Disease; Cancer; PTEN Gene
39 Use of Weber Ferguson Approach: An Effective Option to Reduce Recurrent Maxillary Fibrous Dysplasia , Emrah Kagan Yasar, Can Ilker Demir, Ceyhun Uzun and Murat Sahin Alagoz
Fibrous dysplasia (FD) is a progressive but generally benign disease in which normal medullary bone is replaced by abnormal fibro-osseous tissue. The Weber Ferguson (WF) incision can be used for wider resection due to recurrent fibrous dysplasia affecting the right maxillary bone in a patient with a previous history of reduction surgery with an intra-oral approach. The WF incision is an alternative surgical approach option in cases in which an intraoral approach will be inadequate in patients with recurring maxillary FD sufficiently large to affect social life.Keywords: Fibrous Dysplasia; Infraorbital; Maxilla; Nerve Repair; The Weber-Ferguson Incision
40 Nasal Tip Deprojection- An Incremental Approach , Nanda Vipul, Agarwal Avinash, Sharma Manik
Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration of nasal tip is technically challenging as every small manoeuvre may lead to dramatic outcomes. There is paucity of well-defined guidelines for sequence of steps to de-project nasal tip. We propose an incremental approach for deprojection of nasal tip. It emphasises on re assessment of tip after each manoeuvre to attain a final pleasing outcome.We analysed 60 patients of true over projected nasal tip over a period of eight years. In all patients sequence of surgical steps were the same as described. In the process, when desired tip de projection was achieved, further steps were not performed.Keywords: Rhinoplasty; Nasal Tip; Manoeuvre
41 Nasal Foreign Body Removal by Open Rhinoplasty Approach - An Unusual Case Report , Priyajeet Panigrahi, Tapan Kumar Sahoo
Nasal foreign bodies are very common in children but very rare in adults unless self inflicted. Following a road traffic accident foreign bodies like tiny stone particles and dust even small metallic foreign bodies can enter the wound site and cause inflammatory reaction. Identification and removal of any foreign body is always necessary. Loose foreign bodies are always dangerous because it may travel to posterior nasal space and there is high chance of aspiration. This is a case where a tooth impacted inside nose since 3 months following a road traffic accident. Foreign body was successfully removed by an open rhinoplasty approach. Open rhinoplasty approach is a safe and very effective way of foreign body removal in cases where a conventional endoscopic approach is not feasible. Keywords: Nasal Foreign Bodies; Inflammatory Reaction; Open Rhinoplasty Approach
42 Future of Dentistry in Covid 19 , Amil Sharma
COVID-19 or normally known as a corona virus disease has already been in a pandemic situation which almost grabs many countries in the world. Its outbreak is still at large and even grasp-ing medical professionals too. Corona virus disease or simply Co-vid-19 caused by SARS-CoV-2 infection that affects our respiratory tract i.e. Nose, throat sinus. It can spread if a person came in con-tact with an infected person and infection may range up to mild, moderate and severe. Patients with systematic problems are af-fected by Covid-19. Dental Surgeons uses many instruments like air rotor, hand pieces and ultrasonic scalars with high speed so they have in build water supply to cool it down
43 The Oleaginous Conglomerate-Multiple Symmetric Lipomatosis , Anubha Bajaj
Multiple symmetric lipomatosis (MSL) is an exceptional disor-der of adipose tissue metabolism and lipid storage. The condition was initially scripted by Sir Benjamin Brodie in 1846 and is ad-ditionally designated as Madelung’s disease, Launois-Bensaude syndrome or benign symmetric lipomatosis [1]
44 The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients , Siti Nurfarhana Mohd Arif, Mawaddah Azman, Sharifa Ezat Wan Puteh, Nur Shahrina Mohd Zawawi, Abdullah Sani and Marina Mat Baki
Objectives: 1) to evaluate the reliability of measurements of maximum vocal intensity (maxVI), reading pitch range (RPR) and sing-ing pitch range (SPR); 2) to determine the parameters’ correlation with voice handicap index-10 (VHI-10); and 3) to compare the difference of the parameters between pathology and healthy group.Methods: This cross-sectional study that was performed in a tertiary centre included 30 patients diagnosed with unilateral vocal fold palsy (UVFP) and 30 healthy volunteers (n = 60 participants). The participants’ voices were measured for maxVI (dB) using Sound Level Meter (SLM) at 100 cm and RPR and SPR (Hertz) using OperaVOX at 30 cm distance, from lips. The phonation tasks were vowel /a/ at maximum loudness (maxVI), reading a standard passage (RPR) and glissando mode /a/ (SPR). The measurements were re-peated within 30 minutes interval. Voice handicap index-10 (VHI-10) was documented for all participants. The internal consistency of the measurements was evaluated using intraclass correlation (ICC). Correlation of parameters with VHI-10 was assessed with Spearman Correlation Coefficient. The comparison between two groups was done with Mann Whitney U Test. Results: The reliability of maxVI, RPR and SPR was substantial to excellent with ICC of 0.83 (0.7, 0.89), 0.9 (0.94, 0.97) and 0.62 (0.44, 0.61) respectively. There was a significant difference for maxVI and SPR between the UVFP and healthy volunteers (p < 0.01). MaxVI showed good significant negative correlation with VHI-10 (r -0.63, p < 0.05) whereas RPR and SPR were poorly correlated with VHI-10 (r = -0.126 and r = -0.28, p > 0.05). Conclusion: MaxVI showed good results depicted by its excellent reliability, ability to differentiate between UVFP and healthy volun-teers and good correlation with VHI-10. Thus, MaxVI is may be a potential primary outcome measure in future clinical trials related to UVFP
45 18F-FDG PET/CT in Identifying Primary Site in Patients with Neck Secondaries: A Cross Sectional Study , Darwin Kaushal, Suresh Chandra Sharma, Rakesh Kumar, Bidhu Kalyan Mohanti, Ashu Seith Bhalla and Nithin Prakasan Nair
Purpose: The detection of the primary site in patients with carcinoma unknown primary neck is always a challenge. This study was conducted to assess the role of 18F-FDG PET/CT in detecting the primary in patients with neck secondaries. This study also aimed to compare its diagnostic sensitivity with computed tomography and triple endoscopy.Materials and Methods: We prospectively evaluated thirty two patients of carcinoma of unknown primary who presented with cervical lymphadenopathy. Inclusion criteria were all patients who had a fine-needle aspiration of cervical lymph node suggestive of squamous cell carcinoma without clinically detectable primary site. We did a clinical and radiological evaluation for all patients. All patients were subjected to further assessment by a triple endoscopy and 18F-FDG PET/CT. Following 18F-FDG PET/CT, we took a biopsy from the suspicious site in all patients. The biopsy reports were collected.Results: The primary detection rate was 18.8%. With the help of PET CT, biopsy confirmed primary site was detected in 6 patients. The sensitivity, specificity, positive predictive value, negative predictive value of PET-CT were 100%, 34.6%, 26.1%, 100% respec-tively. Conclusion: 18F-FDG PET/CT has higher sensitivity, detection rate and negative predictive value as compared to computed tomog-raphy and triple endoscopy
46 COVID 19 Battle: The Evolving Enemy , Arya Ajith
As the month of April comes to a debilitating end, there are two extremes of numbers seen. Extremely high (and still counting) number of COVID-19 cases but low number of provisions for the same. The catastrophic second wave of the COVID 19 infection has devastated India. Despite having a strong response at the onset of the COVID 19 pandemic, India now has the World’s fastest growing outbreak of the corona virus infection. The cataclysmic nightmare is rapidly sliding into a devastating crisis, with hospitals exceeding their capacity and with paralyzing shortage of oxygen and drugs.
47 Skin Prick Test - A Useful Tool in Diagnosis of Unexpected Triggers and Management of Allergy , Dr Prashant Kewle, Dr Amrapali Keny-Pawar
The prevalence of allergy is on the rise with increase in urbanisation and environmental pollution. Skin Prick Test serves as a useful tool for detecting the allergens that trigger allergy in atopic individuals. The Skin Prick Test can be done with a few allergens (3 or 4 substances) or sometimes as many as 40 to 50 substances. In this paper, we have emphasized the importance of performing Skin Prick Test with more numbers of allergens while dealing with a patient of allergy during the management of allergic rhinitis, asthma or urticaria. We should bear in mind that a significant number of these patients also suffer from Food Allergy Syndrome, which is often missed and underdiagnosed, if the SPT is done with fewer number of allergens.
48 Masks, Masking the Facial Expression and Lip Reading: Added Burden for Hearing Impaired during COVID-19 , Anjali Singal
The confirmed cases of COVID-19 are increasing in India even after more than a year of the pandemic (as of April 19, 2021). The standard preventive measures to fight against the virus are to wear face mask, social distancing, frequent hand washing or sanitizing and to get vaccinated, if eligible. The masks act as a physical bar-rier to guard you and others from the infection. Un-doubtfully wearing a mask, especially if in close proximity to others, is im-perative to break the chain and contain the spread of COVID-19.
49 The Maladjusted Crystallization-Non Ossifying Fibroma , Anubha Bajaj
Non ossifying fibroma (NOF) is a benign neoplasm of fibrous tissue origin appearing on account of dysfunctional ossification. The neoplasm is additionally designated as metaphyseal fibrous defect, non-osteogenic fibroma, cortical desmoid, fibrous cortical defect, fibromatosis or fibroxanthoma.
50 Case Series-Intraparotid Facial Nerve Schwannoma: Our Experience in 5 Cases , Nitin Gupta, Shashikant Anil Pol, Surinder K Singhal, Himanshu Chhagan Bayad, Ranjeev Bhagat, Arjun Dass and Himani Gupta
Intraparotid Facial Nerve Schwannoma is an exceedingly rare tumor of head and neck region. It forms about 0.5% - 1.2% of all parotid tumors. It is neuroectodermal in origin. Facial nerve schwannomas are benign, encapsulated, slow growing tumours that arise from nerve sheath. Most common presenting complaint is unilateral facial swelling though facial paralysis is seen in few of the patients. Fine needle aspiration cytology (FNAC) and radiology play a key role in preoperative diagnosis. Treatment of choice for fa-cial nerve schwannomas is complete surgical excision. Here we are reporting 5 cases of facial nerve schwannomas which lies within the parotid gland region. All the patients presented with unilateral facial swelling from the year 2017 to 2020. Clinical features, diagnosis and management of these cases are discussed here. We recommend that before going for excision, patient should be made aware of the possible functional facial deficit and as per the patient’s priority, decision of excision should be made. After complete excision, recurrence rate was found to be extremely low. Usually, post-operative functional deficit recovers almost completely with physiotherapy.
51 Polymorphous Low-Grade Adenocarcinoma: A Case Report , Isadora Kamila Oliveira Silva1, Marina Siqueira Teixeira1, Victoria Dias de Miranda Paula Barroso1, Alessandra Oliveira Ferrari Gomes2, Silvia Paula de Oliveira3 and Luisa Aguirre Buexm
Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm featuring low aggressiveness and almost exclusively originated from minor salivary glands. A case of PLGA is reported in an 81-year-old female patient who attended the stomatology clinic reporting an increase in volume of palate. Intraoral examination revealed a tumor on the right posterior palate, hard in consis-tency and painless. Radiographic examination didn't reveal abnormalities. An incisional biopsy was performed with histopathologic diagnosis of salivary gland malignant neoplasm. Immunohistochemically the tumor cells were positive for EMA, CEA, p63, CK14, vimentin, S-100 protein and Ki-67 (< 1%), but negative for smooth muscle actin and GFAP. The patient underwent surgery with tumor-free margins, confirming PLGA. An obturator prosthesis was placed after surgery. PLGA is a slow-growing, distinct, uncommon neoplasm of the minor salivary glands. Because it is characterized by a diverse morphologic pattern that resembles adenoid cystic carcinoma or pleomorphic adenoma, the initial diagnosis is usually inconclusive.
52 Facial Palsy: The Right Time for the Right Choice , Della Monaca M, Giorgio Barbera, Andrea Cassoni, Andrea Battisti, Paolo Priore, Ingrid Raponi*, Valentina Terenzi, Filippo Giovannetti and Valentino Valentini
Aim: The aim of this study is to propose our experience and our protocol in post-operative facial palsy. Methods: A retrospective study about 32 patients was done. Timing of the palsy onset, surgical indications and the results using Facegram were analyzed.Results: The mean improvement for acute palsy evaluate with Facegram analysis of corner of the mouth excursion during smile was 41,30%. In the mid-term paralysis the measured improvement was 29,12%. Finally in the long - term facial palsy treated with func-tioning muscle transplantation was 34,30%.Conclusion: Facial nerve reconstruction should be addressed routinely in every patient who undergoes facial nerve resection or develop palsy after otologic or brain surgery.
53 Sudden Sensorineural Hearing Loss: An Updated Review , José Luis Treviño-González PhD MD*, Felix Maldonado MD, Germán A. Soto-Galindo MD, Jesús Eduardo Hernández de León MDa, Laura Lisset Reyes Suárez MDa
Sudden sensorineural deafness is defined as a hearing loss greater than 30 dB in 3 contiguous frequencies of pure tones that occur within 72 hours. It is a rare but disabling entity, affecting approximately 5 - 27 people per 100,000 globally per year. The etiology is identified only in a few cases, being a viral infection the most associated cause. The diagnosis is based primarily on the medical history, physical examination, and pure tone audiometry. The mainstay of treatment is corticosteroids, either systemic or intratympanic. This treatment can be accompanied by hyperbaric oxygen therapy to improve the response. For the follow-up, serial audiometric studies are suggested at the end of the treatment and six months, in search of residual hearing loss.We examined the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment of sudden sensorineural hearing loss to provide a comprehensive review on this topic to improve the understanding of this entity among clinicians.
54 Quality of Music Amplified by Hearing Aids , Archisman Shubhadarshan1 and Sushmit Mishra
Hearing aids are known to produce deleterious effect on music perception. This study explored how music perception through hearing aids can be improved. The recorded samples were rated subjectively by three groups of adult listeners. Group 1 consisted of 15 non-musicians, Group 2 included 15 professional singers and Group 3 comprised of 10 instrumentalists. The digital hearing aids were programmed for a flat 50 dB HL hearing loss. In this experiment, four-channelled (HA A) and fifteen- channelled (HA B) hearing aids were used. The knee-points of the hearing aids were set at default setting and at the highest possible setting. The noise reduction system and feedback management system were either turned off or on. A total of seven music samples processed through hearing aids were recorded along with the original sample using the same set up. The subjects rated all these music samples on a five-point perceptual rating scale that was relevant to music. Furthermore, the music samples were evaluated objectively by using the PRAAT software. In every parameter of perceptual analysis, it was observed that the highest rating was given to the original music sample followed by the music sample recorded through HA B with knee-point high, signal processing off and HA A with knee-point high, with signal processing off, respectively. The objective analysis results were similar to subjective analysis. This study demonstrated that a multi-channel hearing aid with knee-point set high and signal processing turned off provided the best representation of original music sample which is in agreement with a previous study.
55 Role of Drug Induced Sleep Endoscopy in Diagnosing the Site and Severity of Obstruction in Patients with Obstructive Sleep Apnoea , Aditi Mahajan1* and Susan K Sebastian
Introduction: The surgical management of Obstructive sleep apnoea (OSA) is based on the site and severity of obstruction of upper airway. The present study has evaluated these factors by performing a preoperative drug induced sleep endoscopy. The study aimed at diagnosing the site of obstruction in patients with obstructive sleep apnoea symptoms by drug induced sleep endoscopy and their relation to obstructive sleep apnoea syndrome severity.Materials and Methods: The study was conducted on 30 patients aged between 12 - 65 years, presenting with symptoms of obstruc-tive sleep apnoea. All patients underwent drug induced sleep endoscopy in operation theatre under propofol sedation.Result: In our study the sleep endoscopy findings revealed multilevel obstruction in 90% patients with maximum obstruction seen at retropalatal site. All 30 patients had varying degrees of retropalatal obstruction. Hypopharyngeal obstruction was seen in 83.33%. Next common site of obstruction in patients was the base of tongue, causing obstruction in 50% of the patients. Least common sites were the nose/nasopharynx and larynx. In larynx, epiglottis was the common site of obstruction.Conclusion: Drug Induced Sleep Endoscopy is a useful tool for the preoperative assessment and surgical planning OSA patients un-dergoing surgery management.
56 Clinical Presentation of Two Patients with Marjolin’s Ulcer Presenting in an Area of Previously Burned Skin: A Case Report , Marko Barić
Background: Marjolin's ulcer (MU) refers to an aggressive ulcerating squamous cell carcinoma (SCC) presenting in an area of previ-ously traumatized, chronically inflamed, or scarred skin. They usually develop in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention or burn wounds which never healed completely over years and the unstable post-burned scars. Lower limbs represent the most frequently affected body parts. Treatment is usually surgi-cal, with a wide excision of the lesion; typically, a 2 - 5 cm margin all around is required. Despite best efforts, the overall mortality is reported to be 21%. The aim of this case report was to present two of our patients suffering from mistreated and misdiagnosed Mar-jolin’s ulcer, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Treatment of both pa-tients was surgical and radical, whereas in the first patient, high femoral amputation with the stump reconstruction was performed. In the second patient, after a radical excision in sano and an extirpation of supraclavicular lymph nodes, a defect was reconstructed with rotational pedicled island myocutaneous latissimus dorsi flap. Conclusion: Reconstructive surgery provided a dramatic cosmetic improvement with significant psychosocial benefit. Unfortunate-ly, high-grade tumours have significantly high amount of recurrence and positive lymph node metastases, so repeated surgical pro-cedures may be required. Keywords: Marjolin’s Ulcer; Malignant Degeneration; Post-Burned Scars and Wounds; Squamous Cell Carcinoma; Full Thickness Skin Burns; Healing by Secondary Intention
57 Is it Necessary to Delay the Surgery for Patients who have had Covid-19? , Luis Alejandro Boccalatte
As part of the Review Board at Acta Scientific Otolaryngology® I would like to share my experience as National Lead in Argentina in this huge study. I started joining the main group, which is located in the United Kingdom, as collaborator in April. The first two stud-ies were called “COVIDSurg” the first one and “COVIDSurg-Cancer” the second one. Both Surg and Cancer studies have several publica-tions and huge impact in the surgical community [1,2]. Due to the number of patients that Argentina had enrolled, in August 2020 the main group in the UK invited me to take part in this project as national lead in my country. Also, I was designated a member of the dissemination committee in order to establish the protocol in Ar-gentina and contribute to the release into the scientific community
58 Critical Issues and Challenges in Conducting Clinical Trial during the Covid-19 Pandemic , Shehnaz Kantharia
he COVID-19 pandemic has an ongoing impact on the conduct of clinical trials across the world and India is no exception. The dis-ease has the potential to impact the scientific integrity and patient safety of ongoing trials. It has also affected the trial patient recruit-ment and retention. This may be due to several reasons like self-isolation/quarantine by patients and study site personnel, travel restriction across various districts of a state or interstate travel and also blocked access to Clinical trial sites in hospitals which may have been converted to Covid Care centres.
59 COVID19 and Epistaxis , Casas Ocando Julio
Cases of pneumonia of unknown origin caused by a new coro-navirus, SARS-CoV-2, were detected, in the Chinese city of Wuhan in December 2019, it has evolved rapidly into a public health crisis and the epidemic is declared on January 31, 2020, by the World Health Organization (WHO) and a pandemic on March 11 because has spread exponentially worldwide [1]
60 Headache as a Presenting Symptom in the Field of Otolaryngology , Haider Alsarhan
Headache as a chief complaint usually raises the thinking of the otolaryngologists to acute or chronic sinusitis or other nasal ENT problems; Although that way of concrete thinking is not wrong, it is very important for the otolaryngologist to be more open-minded and think as much as possible as a physician rather than otolaryn-gologist. A simple review of a sample of the literature of the causes of the headache can show a long list of causes that is related to dif-ferent specialties other than otolaryngology including neurology, neuro-surgery, ophthalmology, pharmacology, toxins, allergy and emergency medicine... etc. Zara M Patel., et a
61 Tuberculous Otitis Media - A Case Report , Swetha Chevula, Vani Padmasri M, Karuna N, Srivani N andCaptain L Sudarshan Reddy
Objective: To publish a rare case of tuberculous otitis media in an 18 year old male patient.Methods: An 18-year old male presenting with bilateral hard of hearing since 9 months was evaluated thoroughly by clinical exami-nation, hematological, radiological and histopathological evaluation.Results: Clinical examination revealed a single pinkish polypoidal mass with granulations occupying the right external auditory canal. Hematological investigations were within normal limits. Sputum for AFB was positive for Mycobacterium tuberculosis. Radio-logical evaluation with computed tomography showed soft tissue density in the bilateral prussack’s space and the epitympanum with erosion of the scutum. Biopsy was taken from the right aural polyp and the patient was managed conservatively. Histopathological examination showed squamous epithelium lining with sub-epithelium, showing areas of caseous necrosis surrounded by epithelioid cell clusters, lymphocytes and plasma cells along with dense neutrophil collection, karyorrhectic debris and areas of hemorrhage with few multinucleate giant cells. With all the above evaluations, diagnosis was concluded as tuberculous otitis media.Conclusion: It is a rare case presentation of Tuberculous otitis media.
62 Non-odontogenic Sinonasal-induced Toothache; a Communication Bridge Between Dentistry and Otolaryngology , Behzad Cheshmi*
The common innervation by maxillary division V2 of the tri-geminal nerve and anatomical proximity of maxillary teeth, maxil-lary sinuses and the anterior two-thirds of the nose can sometimes confuse clinicians from different disciplines for the correct diag-nosis of pain etiology in these areas. More specifically, differentia-tion of odontogenic pain, particularly odontogenic pain associated with maxillary teeth, from the pain associated with maxillary sinus problems (such as sinusitis) and nasal cavity problems (such as nasal vestibulitis) is sometimes misinterpreted by clinicians in the field of otolaryngology as well as dentistry.
63 Ear Nose Throat Lesions: Role of Imaging in Day to Day Clinical Practice , Rajesh C Kamble
It gives me immense pleasure to write this guest editorial for this upcoming April issue of Otorhinolaryngology journal.Being a radiologist and sonologist, ENT diseases have always come in my day to day practice either for CT, MRI imaging or for neck evaluation by ultrasound
64 Otorhinolaryngology Department during COVID-19 Scenario , Kshitija R Pathak, Rahul Khandekar, Manisha Maske and Santosh Jadhav
Purpose of this article is to give a gross idea that how COVID pandemic has affected the Otorhinolaryngology department in last few months and how we have adopted new practices in ENT OPD. This study consists of general presentation of patients coming to investigator in ENT OPD, detection rate of RAT and RTPCR tests and how we have modified our OPD setup accordingly. Also, we have described about the general measures that were taken during this study period which was from May 2020 to February 2021 in Dr. Vaishampayan Memorial Government Medical College and Ashwini Rural Medical College, Hospital and Research Center, Solapur. Keywords: COVID-19; URTI; Detection Rate; Anosmia
65 A Paradoxical Intruder Disfiguring the Face: Nasal Benign Fibrous Histiocytoma , BP Belaldavar, Rajesh Radhakrishna Havaldar, Vijayalaxmi M Dhorigol, Kavya Garg and Sneha A Sankaran
Benign fibrous histiocytoma is an uncommon presentation in the head and neck region. Composing of fibrous and histiocytic elements, these tumor are known to recur in almost a third of the cases if not excised completely. We hereby report a case of Benign Fibrous Histiocytoma (BFH) of the nasal dorsum completely removed by external approach. Although clinically the possibility of this diagnosis was not suspected, the procedure was tailor made right from the incision to excise the lesion in toto leading to no residual tumor or any morbidity. Knowledge of the possibilities of rare pathologies presenting as benign cysts should not be ignored in the head and neck. Keywords:Benign Fibrous Histiocytoma; Nose; Head and Neck
66 Inflammatory Myofibroblastic Tumor in a Known Case of Squamous Cell Carcinoma of Same Site - A Rare Case Report with Review of Literature , Srinitya Mulukutla, Shubhra Sharma, Sachin Wani, Hiral Shah and Ankit Shah
Background: Inflammatory myofibroblastic tumor is a rare and distinct disease entity comprising of myofibroblastic cells with in-flammatory infiltrate. It was first described in the lungs in 1939 and since then few reports have been made of its occurrence in the oral cavity. As it clinically and radiologically mimics a malignant lesion, the correct diagnosis is imperative to avoid radical treatment.Methods: We describe a case of 44 year male with a significant past history of squamous cell carcinoma of buccal mucosa, presenting with Inflammatory myofibroblastic tumor arising from same site. Patient presented with a solitary, well circumscribed lesion arising from buccal mucosa and gingival sulcus. Results: Final histopathology was suggestive of inflammatory myofibroblastic tumor showing compact proliferation of spindle cells arranged in a storiform pattern, with predominantly lymphoplasmacytic cells infiltration.Conclusion: Inflammatory myofibroblastic tumor can be accurately diagnosed with thorough understanding of histology and im-mune profiling which avoids unnecessary and extensive treatment protocols. No other case with a previous history of Squamous cell carcinoma of same site has been reported in literature.Keywords:Buccal Mucosa; Inflammatory Myofibroblastic Tumor; Oral Squamous Cell Carcinoma
67 Degree of Satisfaction among Postlingual Cochlear Implant Users in Oman , Naif Ali Al-Shashai, Noraidah Binti Ismail  and Marina L Alisaputri
Background and Objectives: The reliability of cochlear implant in aural rehabilitation has been reported in numerous medical and healthcare related journals and its implementation are widely seen in many rehabilitation centers. However, the use of cochlear im-plants can be affected by the satisfaction of cochlear implant users. In addition, there is little or no data on the satisfaction of cochlear implant user in Oman in the literature. Hence this research considers conducting the study to find out the post-cochlear implantation satisfaction of postlingual Omani adult and adolescent users. Subjects and Methods: The number of participants in this study was 21 (12 males and 9 females) and their age ranges from 15 years to 65 years. An Arabic version (back-to-back translated) of Satisfaction with Amplification in Daily Life (SADL) Questionnaire was used in the study to estimate the participants’ satisfaction and was correlated with the participants’ results of speech perception tests. Results: All participants with the exception of one were satisfied as obtained from the SADL questionnaire. There was a significant correlation between the outcomes of speech perception tests with visual clues and the overall score of the SADL questionnaire (r = 0.522) and it is significant at α ≤ 0.05. Conclusion: The results produced in this research are positive, further studies with a larger sample size are needed to generalize the findings.Keywords: Satisfaction; Cochlear Implant; Oman; Satisfaction with Amplification in Daily Life
68 Versatility of Local Rotational Flaps on the Management of Traumatic Facial Injuries: A Case Report and Review of the Literature , Nicolás Solano, Ejusmar Rivera, Anixa Álvarez, Ana Villarroel and Carlos Medina
The reconstruction of traumatic facial injuries of soft tissues represents a challenge for the surgeons due to its anatomical com-plexity. The use of local rotational flaps in these defects is a great advantage since it allows the restoration of the facial contour, leaving a scar in prudent areas with proper planning; it can be performed without complications and with minor surgical time. The objective of the present study was to show the use of the local rotational flap as a treatment of traumatic facial injuries by reporting a clinical case, a male patient who suffered facial trauma after interpersonal violence with a sharp pointed object. Initial wound management is performed on a delayed basis and at 3 weeks later, direct wound closure is performed in the chin and parotid region, in addition to a locally rotated flap in the left buccal region. In our experience, the use of local rotational flaps is an advantage for closure in traumatic facial wounds, being an alternative of choice due to its versatility in design, providing functional results with aesthetic outcomes.Keywords: Facial Injuries; Facial Trauma; Rotation Flap; Reconstructive Surgery; Case Report
69 Recovery from Auditory Neuropathy Spectrum Disorder Post-Traumatic Brain Injury: A Case Study , Suman S Penwal and Chandrahas U Chandanshive
Background: Auditory neuropathy spectrum disorder is a retrocochlear pathology. It is marked by an abnormal transmission of stimuli by the auditory nerve. The purpose of the study is to illustrate the audiological profile of the infant with post-traumatic brain injury and subsequent recovery observed in follow-ups.Methods: In the present case study report a 3-month-old infant was undertaken for detailed audiological evaluations and follow-up. The infant was suffering from right-sided paresis post head injury. The case underwent the diagnostic audiological test battery using standard norms and protocols. All the test procedures were non-invasive and complied with the declaration of Helsinki.Results: The audiological test array suggested the presence of auditory neuropathy spectrum disorder in the left ear. However, the absence of contralateral reflexes in the opposite/ better ear was suggestive of bilateral retrocochlear pathology. The repeat evalua-tion revealed recovery from the retrocochlear pathology.Conclusion: The recovery was attributed to the activity-dependent neuroplasticity and spontaneous drainage of neurotoxic blood accumulation in the brain.
70 Subcutaneous Venolymphatic Malformation in the Neck: A Unique Presentation , Vishnu Varathan Moganadass, Shashi Gopalan and Kasturi N
Venous malformation is one of the most common type of congenital vascular malformation which normally involves the lymphatic system. It is a common type of congenital vascular lesion with recorded incidence of 0.01%, from this 0.01%, 40% is from the neck region, 40% occurs in the trunk, and another 20% in the extremities. The pathogenesis remains unclear. This article elaborates on the type of venous malformation, imaging modality assisting to come to a definitive diagnosis. Surgical excision is the best compared to non-operative method in managing superficial well encapsulated localized venolymphatic malformation
71 New Born Hearing Screening-An Essential Tool in Early Identification of Deafness in Children , Bhavya BM, Trupti U Bhat and Neeraj Suri
Background:Hearing impairment is one of the most critical sensory impairments. Universal Newborn Hearing Screening (UNHS) is a standard practice in most developed countries. However, in developing countries like INDIA many obstacles like unawareness, inaccessibility, lack of infrastructure reduce the sustainable rate of screening for early identification. This study aims to review the benefits and results of universal newborn hearing screening, to propose a standard protocol for screening of all newborns irrespec-tive of high-risk infants, hospital/home deliveries.Materials and Methods: This cross-sectional study conducted by Department of ENT, GMERS Medical College, Gandhinagar, Gujarat along with TARA foundation screened 31460 neonates, infants and children, between 2017 - 2018. All infants were initially screened with OAE, and those who failed were subjected to ABR/BERA. Results: All children were screened with OAE as 1st stage screening procedure, out of which 4557 (14.48%) showed positive results. At 2nd stage OAE refer children were subjected to ABR, in which 1322 (29.01%) children were found having deafness which was confirmed by audiologist and otorhinolaryngologist. Out of the 1322 diagnosed with deafness, 746 (56.42%) patients had history of NICU admission, 268 (20.27%) patients had history of consanguineous marriage, while 308 (23.31%) patients had no risk fac-tors. Thus highlighting the risk factors in congenital deafness detection, and the need for universal screening over selective high risk screening.Discussion: Current recommendations are to screen all infants for hearing loss early in life for timely intervention. A two-step screening with OAE and ABR has to be implemented which can reduce the no of missing cases due to lost follow up. A new initiative ‘DHWANI on wheels’ has been implemented with OAE and ABR carried out by trained audiologists in a mobile van, to tackle the issue of inaccessibility and unawareness in remote areas. Conclusion: As normal hearing is critical for speech and language development, UNHS is a strategy that enables to identify congeni-tal hearing loss early and provide appropriate intervention as early as possible for optimal benefits.Keywords: UNHS; OAE; ABR; Neonatal Hearing Screening; Congenital Hearing Loss
72 3D Scanner Applied to Patients Under 18 Years of Age: Has the Time Come to Rewrite the Regulations for Use? , Barbero A, Morales M and Roldán L
The arrival of 3D digital scanning systems for patients' ears has revolutionized one of the most classic fields of Audiology, that is, the manufacture of custom silicone molds for the patient's ear. This is an efficient and clean system due to the accuracy it provides. But while performing 3D ear scanning for children, we face a big obstacle. That obstacle is that the instruction manuals of the manu-facturers of the 3D Scanner indicate that it is used only for those over 18 years of age. In other words, we must give up one of the most important fields of our profession which is Pediatric Audiology.This aspect is treated in this opinion article from the perspective of the authors' own experience and reflects their personal contribution in this field throughout their 30 years of work and experience, making classic silicone molds and the new 3D molds by scanning. Our opinion article is intended to suggest a change in the current use of 3D scanning with children.The exact copy of the ear is a tremendously important aspect while examining patients with severe and/or profound deafness, especially at an early age. But there are some teenagers of 12, 14 or 16 years old, who have a wide enough conduit to be able to use the Otoscan 3D, especially if they have been using tight molds since they were little. And there are also adult patients with a very small ear canal, which makes scanning impossible.For this reason, our proposal and recommendation is to change the instruction manuals for use from 2021 so that the limitation is not based on age, but on the diameter of the ear canal. In this way, the responsibility of the manufacturers of the equipment is safeguarded (which is one of their main concerns and basis of the reason, in the event of possible legal claims), and allows flexibility in use based on a technical/audiological criterion, instead to be based on a mere question of ages
73 Tuberculosis in Otorhinolaryngology Uncommon but Not Rare , Casas Ocando Julio
Tuberculosis is one of the principal causes of disease and mortality in the world, occurs in children and adults, as an acute, sub-acute, or chronic infectious disease which affects all tissues of the body and represents approximately 80% of tuberculosis cases in adults. Of the forms of extrapulmonary tuberculosis, the most frequent location is lymphatic and is rarer in the ENT area but is still an important form of extrapulmonary tuberculosis, which makes it an important clinical and diagnostic challenge to the otolaryngolo-gist. The diagnosis of disease must be demonstrated by the culture of Mycobacterium tuberculosis or by histology.Keywords: Tuberculosis (TB); Mycobacterium tuberculosis; Otorhinolaryngology
74 Intracranial Tuberculoma , Ramakrishna Bethanabatla and Ahmad Taha
Mycobacterium tuberculosis (MTB) intracranial tuberculomas are rare and account for approximately 1% of all cases. Central nervous system (CNS) involvement is a serious condition if not treated adequately. We present a case of a lady who presented with Headaches.Keywords: Mycobacterium tuberculosis (MTB); Central Nervous System (CNS);Intracranial Tuberculoma
75 Case Report: Submandibular Metastasis in a Case of Buccal Malignancy: Role of Ultrasound , Rajesh C Kamble, Alpana N Joshi and Pravin Mestry
Head and neck cancer is the 6th most common malignancy worldwide, and oral cavity tumors account for nearly one-third of the tumors. It’s become usual trend to subject head and neck cancer patients for CT scan/MRI neck to diagnose these primary lesions and evaluate its loco regional as well as distant spread.This case report strongly emphasizes the role of high frequency linear transducer and intra oral ultrasound imaging for diagnosis of oral cavity tumors.Cervical lymph node metastasis plays an essential role in the treatment and prognosis of head and neck cancer patients. The assessment of the cervical lymph node status still remains an unsolved problem and ultrasound can be a great tool to detect these lymph nodes, characterize them and also in follow up of all post-operative patients.Real time USG guided FNAC/tru cut biopsy of these lesions can help in primary diagnosis of these neoplastic lesions.Keywords: Submandibular Metastasis; Buccal Malignancy; Intra Oral and High Frequency Ultrasound
76 Rare Case of Benign Spindle Cell Lesion in Subglottis , K Krishna Kumar and VJ Niranjana Bharathi
An upper airway obstruction secondary to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report a 16 year old girl who was misdiagnosed as bronchial asthma whereas finally diagnosed as spindle cell lesion of subglottis. The challenging feature of head and neck pathology is a varied array of spindle cell lesions ranging from reactive to malignant and very aggressive. Hence an accurate diagnosis is critical which can be obtained with the help of diagnostic and radiological facilities.Keywords: Subglottic Mass; Spindle Cell Lesion
77 Mucormycosis - The Dark Shadow of Coronavirus , Arya Ajith
As the crippling crisis of Covid-19 infection continuous to dev-astate India new deadly complications of the infection have sur-faced. The Coronavirus’s new partner in crime is the deadly fungal infection mucormycosis or as the media has named it “Black Fun-gus”.Mucormycosis is a rare but deadly opportunistic fungal infec-tion, commonly seen in immunocompromised patients. It belongs to saprophytic fungi group - Mucorales order and Zygomycetes class. The mode of infection is usually via the inhalation route and infection begins in the nose and paranasal sinuses with vascular invasion, forming thrombi in the blood vessels, leading to reduced blood supply and tissue necrosis of nearby tissue and osteomyeli-tis. It is an aggressive and potentially fatal infection more common-ly observed in immunocompromised patients.
78 Impact of the Covid 19 Pandemic on the Wellbeing of Children , Radha Balaji
Starting from December 2019 the COVID-19 disease caused due to SARS-CoV 2 virus spread its wings all over the globe by Feb-ruary 2020 and was declared a Pandemic in February 2020 by WHO. With no immediate treatment available countries resorted to adopting stringent preventive measures such as social distancing, wearing of face masks and frequent hand washing. As these mea-sures did not yield the desired results, authorities to breakdown the chain of the virus transmission, enforced lockdown measures of varying degrees resulting in the closure of schools and educational institutions, and denial of access to public places such as gardens, malls, theatres and religious places where large assemblages are unavoidable. While house quarantine affected all, the impact of confinement in homes has had a serious adverse effect on the physical and mental health of growing children. School closures have led to lack of outdoor activity, aberrant dietary and sleeping habits, physical inactivity sedentary behaviour and anxiety with poor cognition. Studies conducted across many countries have sought to analyse the impact of the pandemic from different perspectives. Most of the studies were on the children as a whole without taking into consideration their socioeconomic conditions. However, in this paper, we analyse the impact of the Pandemic on children of different strata in India. The effects of home quarantine were studied by dividing the children into two socioeconomic groups - children from well-to-do households and children from underprivileged families. The studies of a few (20 in number) children were found to be on the lines of investigations of children elsewhere. Keeping in mind Indian conditions particularly concerning underprivileged children certain recommendations are made over and above the guidelines of WHO. Implemented by parents, caretakers and elders at home we may minimize the ill effects of home quarantine dur-ing the lockdown periods.Keywords: Covid-19; Physical Activity; Mental Health; Underprivileged Children
79 Clinicopathology Study of Middle and External Ear Lesions: A Ten-Year Retrospective Study, Yazd, Iran , Hamed Ghoshouni, Shokouh Taghipour Zahir, Parastou Mahdaviyeh, Koorosh Rahmani and Mohammad Shafiee
Introduction: External and middle ear diseases and tumors are among the most common cases referred to the ear clinic. These lesions can range from benign inflammatory lesions to metastatic tumors. Therefore, in this study, we aimed to study middle and external ear biopsy lesions to obtain information about the frequency distribution of gender, age and their clinical symptoms so that we may be able to take steps to detect them early and prevent their spread.Methods: This descriptive and cross-sectional study was performed retrospectively. The data were collected through a premade questionnaire, including demographic data such as age, gender, the precise anatomical location, the involved side, clinical symptoms, and pathology report. Then, the obtained data were statistically analyzed through SPSS software version 17.Results: Total 542 patients were enrolled in this study, whom 332(61.3%) of them were male and 208 (38.3%) of them were female. The mean age of patients was 36.93 18.51 years old. Between them 57 (10.5%) of cases were malignant, and 485 (89.5%) were benign. There was a significant relationship between the pathologic types of middle and external ear lesions with age, gender, and clinical symptoms (PV < 0.001). Most lesions were seen in men older than 50 years. The benign lesions such as cholesteatoma were the most widespread lesion in the middle ear, mostly observed on the left side. The majority of patients with cholesteatoma were between 20 and 39 years old.Conclusion: The results of this study showed that there is a close relationship between clinical symptoms and the type of the lesion. Most benign lesions presented with otorrhea and hearing loss, while most malignant lesions were presented as ulcerated lesions.Keywords: External Ear; Middle Ear; Pathology; Lesion
80 Early Identification of Hearing Loss in New-Borns - A Challenging Process , Saravana Jayabalan
Acta Scientific Otolaryngology Volume 3 Issue 6 June 2021Early Identification of Hearing Loss in New-Borns - A Challenging ProcessSaravana Jayabalan*ENT Specialty Clinic, Al Kuwait Hospital, Dubai City, United Arab Emirates*Corresponding Author: Saravana Jayabalan, ENT Specialty Clinic, Al Kuwait Hospital, Dubai City, United Arab Emirates.NewsletterReceived: May 18, 2021Published: May 28, 2021© All rights are reserved by Saravana Jayabalan.Neonatal hearing screening also known as early hearing de-tection and intervention programs in several countries refer to those services aimed at the early identification, intervention and follow up of infants who are all vulnerable with hard of hearing. It’s important to know what to expect as our babies grow, because hearing problems can delay the development of speech and lan-guage skills. In 1970, the American speech and hearing association, American Academy of Ophthalmology and Otolaryngology, Ameri-can Academy of Paediatrics to form a national Joint committee on infant hearing (JCIH)
81 Is there Risk of Hypercapnia from Prolonged Use of N95 Filtering Facepiece Respirators? , Nicolás Solano, Arianny Peraza and Enmanuel Parra
Due the pandemic outbreak associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the use of PPE is of vital importance allowing the prevention and control that can limit the spread of the disease. According to the FDA, an N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne par-ticles, where its edges are designed to form a seal around the nose and mouth. Maxillofacial surgeons, as well as others who perform procedures in the head and neck region, are at high risk of being exposed to and infected by COVID-19 [1]. Lately, there has been concerns about the risk of the prolonged use of N95 filtering face piece respirators (FFR) as a part of personal protective equipment (PPE) on the healthcare workers, however, research associated with the potential long-term physiological impacts on the use of N95 FFRs has been limited.
82 Mucormycosis in Context of the COVID-19 Pandemic , Puja Chatterjee
While the coronavirus 19 pandemic continues to be a world-wide healthcare crisis, we might be heading towards an era of post covid complications of near pandemic proportions.Rhino-orbital Mucormycosis is a well-known deadly, acute and aggressive infection affecting patients in Otolaryngology practice. This disease particularly affects immunocompromised patients and those with diabetes mellitus. It is caused by inhalation of spores of fungi in the order Mucorales, most commonly from the genera Rhizopus, Mucor and Rhizomucorwhich are ubiquitous in nature in soil, growing rapidly with spores that can become air-borne. The enzyme Ketone reductase enables these organisms to thrive in glucose rich, acidic environments. Two out of three cases of Mucormycosis are sinonasal
83 Mucormycosis Infection in COVID-19 Patients in India: An Emerging Lethal Threat , Nazia Begam and Abu Bashar
Opportunistic fungal infections have been reported to be asso-ciated with COVID-19 disease. Mucormycosis, an invasive fungal disease is being increasing being reported from India in patients with COVID-19 infection with comorbidities like diabetes. The in-creasing number of mucormycosis cases among Covid-19 patients during the current second wave of the pandemic is alarming own-ing to lethal sequels of the disease
84 Childhood Obstructed Sleep Apnoea and the Role of the ENT Surgeon , Nalini Bhat
Obstructed Sleep apnoea (OSA) is characterized by oxygen de-saturation and reduced upper airway airflow despite preserved thoracic and abdominal effort. It occurs due to periodic partial col-lapse of the upper airway during sleep. It is typically associated with the elderly, especially males. The incidence of childhood OSA is much less (1 - 4%) [1] as compared to adults (20%)[2]. Yet the effect of prolonged poor sleep and inadequate oxygenation can have several deleterious effects on the child’s health. OSA has been reported to cause poor feeding and failure to thrive, developmen-tal delay, hyperactivity, learning difficulties, personality changes and depression in children. It has also been reported to result in hypertension and cardiac issues in the long term
85 Modified Labiomandibuloglossotomy Approach for Solid Tumor of the Floor of the Mouth: A Case Report and Literature Review , Nicolás Solano, Bairon Castro, Ejusmar Rivera and Anixa Álvarez
Surgical access for tumors found on the floor of the mouth represents a challenge for surgeons due to its location. Different tech-niques have been described for this type of tumors (transcervical, transmandibular, transparotid, transoral), however, sometimes they have anatomical limitations. The purpose of this study is to describe a modified labiomandibuloglossotomy approach through a case report of a 36-year-old male diagnosed with adenoid cystic carcinoma on the floor of the mouth. Performing this technique allows more exposure for the resection of these tumors, without damaging the adjacent anatomical structures. Previous planning and respect for facial aesthetic subunits as references for surgical incisions optimize the aesthetic results and wound healing when performed appropriately. The proper selection of the patient, exposure, modification of the surgical technique and its complications will be discussed.
86 Emerging Trends and Recent Advances in Microvascular Anastomosis in Reconstructive Surgery , Deepthi Shetty.
Ablative procedures in head and neck region requires compos-ite removal of tissues during excision. This results in compromise of both functional activities and aesthetic mutilation. Reconstruc-tion of major extirpative defects is an extremely challenging task [1].During the last three decades there has been tremendous progress in the field of reconstructive surgery particularly with the advent of micro vascular free tissue flaps [2]. The transfer of vascularised free tissue is a cornerstone of modern reconstructive surgery which has improved the quality of life in many patients [3].
87 Comprehensive Role of Otorhinolaryngologists in the Management of Headache: A Prospective Tertiary Care Centre Based Study , Rajwant Kaur; Pawan Kumar.
Headache is most common complaint of human being. Classified into primary (migraine, tension headache and tri-geminal neuralgia) and secondary (infectious, vascular and drug induced). Sinugenic headache is deep seated, dull aching with full-ness and heaviness in sinus area. The purpose of study to assess the comprehensive role of otorhinolaryngologists in the diagnosis of headache and to evaluate the efficacy of medical and surgical management of patients presented with headache. 200 patients reported to rhinology clinic with headache. Detailed history, head and neck examination routine blood investigation, fundus examina-tion and anterior rhinoscopy, radiological investigations X-ray paranasal sinuses, skull and cervical spine and direct nasal endoscopy was and CT paranasal sinus preoperatively done
88 Congenital Bilateral Abductor Cord Palsy with Tracheomalacia: A Case in Neonate Managed Conservatively , Mayank Jain; Priya Jain; Shailabh Gupta; AP Mehta;Poonam Sidana.
Congenital stridor due to bilateral abductor cord palsy is rare. Congenital stridor due to laryngomalacia is the most common cause. Congenital abductor cord palsy (ACP) is the second most common cause. Vocal cord palsy (VCP) can be either congenital or acquired. It can be either unilateral or bilateral. Most common cause of abductor cord palsy is idiopathic. Congenital CNS anomaly like Arnold Chiari malformation is the most common cause resulting in B/L ACP. Here we report a case of congenital b/l abductor cord palsy presenting with tracheomalacia
89 Periorbital and Nasal Solitary Fibrous Tumor , Casas Ocando Julio J.
The nasal solitary fibrous tumor is an infrequent benign unilateral tumor, were originally first described as a rare mesenchymal neoplasm that commonly involves the pleura, originating from spindle cells, described in 1931 by Klemperer and Rabin. It is further sub-classified as a benign type of mesothelial tumor; it has been reported in other regions such as: the orbit, nasopharynx, thyroid gland, parapharyngeal space, tongue, major salivary glands, lung, mediastinum, extremities, the liver also rarely affect the nasal cavity and paranasal sinus.The diagnosis is primarily histological, it consists in a positive immunohistochemical finding of CD34.Author report a case of 36 years-old man presented with a 3-month history of persistent progressive left nasal bleeding, left nose obstruction and left eye pain is reported. Physical assessment and nasal endoscopy revealed a pain small rubbery mass palpable in the superonasal quadrant of the left eye and the tumor arose from the left ethmoid sinus and extended to the left nasal cavity and the periorbital area. Further imaging by CT and MRI disclosed a large left-sided nasal and periorbital cavity homogeneous mass, occupying left maxillary sinus, left ethmoid, extending to the left frontal sinus and left orbit. The tumor successfully was removed by endoscopy sinus surgery without complication. The tumor had spindle-shaped cells and was positive for CD34, CD99, Bcl-2 and desmin, histopathological analysis of the specimen was consistent with nasal solitary fibrous tumor. This paper describes the presentation, diagnosis, and treatment of a male patient with a Periorbital and Nasal Solitary Fibrous Tumor.
90 Concomitant Synspondylism and Thoracic Spinal Meningioma, An Extremely Unusual Occurrence , Akshay Agarwal;Utkarsh Mishra.
Lower back pain is an extremely common and rather vague entity with numerous differentials in its list ranging from congenital to non-neoplastic and malignant lesions. Here, we report a rather unusual cause of back pain resulting from congenital and neoplastic etiology. Synspondylism, which is fusion of the thoracic vertebrae and an intradural extramedullary meningioma of suspicious inva-sive pattern of growth in the same patient is discussed along with a brief review of literature.
91 Universities Support for Professors and Students during Covid-19 , Mahdieh Motie;Reza Dehnavieh;Zahra Sarabandi;Sepideh Bani Asad;Khalil Kalavani.
The onset of Covid-19 around the world shut down face-to-face education in schools and universities. Thus, the Coronavirus pandemic replaced face-to-face education with virtual education. Therefore, universities must have necessary infrastructures for e-learning, such as the development of the World Wide Web and accelerating it as well as the capacity to produce educational soft-ware [1]. However, some students may not have access to required facilities for e-learning and may even be affected by the pandemic. So, they need to be supported by the universities [2,3]
92 Bleomycin Sclerotherapy Following Doxycycline Lavage in the Treatment of Ranulas: A Retrospective Analysis and Review of the Literature , Manna Sayan.
A ranula is a mucus-filled salivary pseudocyst that forms in the floor of the mouth, commonly arising from the sublingual or submandibular salivary glands following obstruction or trauma. Complete excision of the injured gland and removal of the cyst content is first-choice therapy, but has the potential for complications related to injury to nearby structures. As such, minimally inva-sive approaches such as percutaneous sclerotherapy have been investigated. We aim to contribute to the literature by assessing the efficacy and safety of our technique through our experience with 18 patients over the last decade.
93 Determining the Relation between PET/CT and Staging in Larynx Carcinoma , DoÄŸan Çakan; Muhammet Gazi Yildiz.
The purpose of this study is to determine the relation between the positron emission tomography/computed tomography (PET/CT) findings and post-operative pathology findings, which is a guiding characteristic for staging in patients with larynx cancer.
94 Kinetic Oscillation Stimulation of Nasal Mucosa as Treatment for Non-allergic Rhinitis. A Pilot Study , Nacie Bello Petersen and Knud Larsen
Introduction:Patients with persistent symptoms for non-allergic rhinitis (NAR) often relay on medical treatment and/or surgical approach. Kinetic oscillation stimulation (KOS) seemed in a few studies to have a positive effect and reduces symptoms for NAR. This pilot study aims to demonstrate effect of KOS in objective and subjective assessment in Danish patients. Method: Fifteen patients with NAR were included and values for nasal inspiratory peak flow (NIPF) , subjective score using SNOT22 and VAS score for pain and patients allover judgement were registered. KOS treatment was offered two times with two weeks interval.Results: Significant change of SNOT22 and NPIF was only present after two treatments. From patients allover judgement there were nine who felt improvement or satisfied but one of these also wanted minor surgery giving a success rate of 53%. The treatment wasaccepted of all patients with no pain but with minor or moderate discomfort.Conclusion:Kinetic Oscillation Stimulation , KOS, of nasal mucosa showed significant effect after second treatment when evaluating sino-nasal-outcome test ,SNOT22 and nasal inspiratory peak flow, NPIF. Patients tolerated the treatment without major discomfort and the patients all over judgement of effect was 53% and was regarded as satisfactory in this pilot study. The result seems to justify further research for which is giving some proposals.Keywords:Kinetic Oscillation Treatment; Non-allergic Rhinitis; Nasal Congestion; Clinical Trial
95 I’m Sorry! You may have to Endure the Oral and Facial Pain a Little Longer , Rasheed Ofosu-Poku.
Head and neck cancers (HNC) are one of the ten leading can-cers globally, and its incidence in Africa in general and Ghana in particular is increasing [1,2]. HNC are associated with profound mortality and morbidity. Pain in face, oral cavity and throat are among the most common presentations before treatment when the tumor is pressing on and invading local structures, during treatment due to severe oral mucositis and effect of radiotherapy on facial and trigeminal nerves and surrounding tissues, and after surgical treatment and chemoradiation due to persistent effect on nerves [3,4]. Patients therefore experience a combination of noci-ceptive and neuropathic pain chronically [5].
96 Overcoming Aphonia in Head and Neck Surgery Patients with VoRA , Delaney H Sheehan;Wayne J Wortmann;Leslie Son2 and Rohan R Walvekar.
Objectives:Our primary objective is to survey patients who have experienced postoperative aphonia after major head neck surgery to understand questions and phrases that were necessary for them to communicate with their healthcare provider. Our secondary objective is to create an application used on an Amazon Fire HD tablet that will allow aphonic patients to interface with their health-care providers.Methods: Survey study of patients in 2019 who had undergone a head or neck surgery resulting in aphonia and who were treated within the Department of Otolaryngology at Louisiana State University Health Sciences Center. Patient demographics and phrases for effective communication were recorded and analyzed. An application for Android Fire HD tablet was then developed using the survey results to vocalize the phrases.Results: Six patients who were surveyed were included. The causes for aphonia included laryngectomy (n = 4, 67%), squamous cell carcinoma excision (n = 1, 17%), and an unspecified vocal cord procedure (n = 1, 17%). The most commonly requested phrases were “pain medication” (n = 2, 33%) and “discharge date” (n = 2, 33%), followed by “food,” “restroom,” “thank you,” and terms to commu-nicate with friends and family. A prototype application was created for use on an Android Fire HD tablet with 12 phrases associated with image icons available in English and Spanish.Conclusions:Patient anxiety is heightened in the post-operative period when communication with providers is limited due to apho-nia. Technology-based solutions can help ameliorate this barrier to optimal patient care. Further studies will demonstrate the effec-tiveness of the application in the patient care setting.Keywords:Aphonia; Voice Restoration; Tracheostoma; Laryngectomy
97 Treatment of Sensorineural Hearing Loss in Children: Platelet Rich Plasma , Brajpal Singh Tyagi
Introduction:Hearing loss is one of the common disabilities in India. The prevalence of this disability is higher in children. The children with sensorineural hearing loss is very common which requires the safe, clinically effective and cost effective method of treatment. Methods:The platelet rich plasma (PRP) was instilled in 24 children od age less than 10 years and the hearing improvement was assessed by the audiogram through BERA or PTA. Results:It was found that 87% patients had bilateral impairment, and maximum patients were with moderate hearing impairment. The rate of improvement was found to be 99% except one patient who had no improvement in the left ear post PRP. Conclusion:In our study, the patients with moderate to profound sensorineural hearing loss were found to have improved hearing levels after treatment with PRP which directly enhanced their speech discrimination levels. Further studies with bigger sample size are needed to establish this method as new doorway for improving the childhood hearing.
98 Hanging Polyp: A Rare Entity in Oral Pathology , Sambhaji G Chintale;Vilas R Kirdak; Swati S Chintale;Kaleem A Shaikh;Sonali P Jatale.
The oral cavity is the first most important part of the gastrointestinal system. In which both types of pathology occurs that may be benign, which are more than malignant, which occurs more frequently in tobacco chewers, smokers, and alcoholic than a person who is non smokers and non-alcoholics. In the oral cavity where most of the diseases presented as the benign lesions may transform into malignancy that’s why any pathology in the oral cavity we have to be careful in handling such pathology. One such case of 45 yr old male smokers presents with difficulty in swallowing due to the enlarged oral hanging polyp for one year.
99 Posteriorly Expanded Supraclavicular Artery Flap Can Reach Distant More Reliable and Safe , Abdolreza Rouientan;Alireza Hoseini Sianaki;Hojjat Molae.
Introduction:Head and neck soft tissue reconstruction by supraclavicular flap is interesting, because of thinness and known ana-tomical landmarks. Distal ischemia and flap missing, evoked considerations to reinforce transferred flap in a reliable way. We tried by introducing expanded posterior supraclavicular flap.Patients and Methods: During 8 years, 11 patients with complex facial scars underwent facial skin defect reconstruction by inser-tion of rectangular tissue expander in a properly matched size in the subcutaneous pocket of posterior margin of ipsilateral supracla-vicular area in the first surgery and then removal of tissue expander and prepared flap transfer to resultant recipient defect. All early and delayed donor and recipient site complications analyzed.Results: 11 patients operated in sequential stages and removed scar defects reconstructed by flap. The mean size of involved area was (201.579 +/_ 24.73) cm2, and after about 3.27 months inserted tissue expanders were removed and flaps used to cover defects. The most significant donor site morbidity was mild hypertrophic scar which did not need operation and only one recipient site with wound dehiscence required secondary surgery.Discussion:Supraclavicular artery flap is used traditionally to cover head and neck soft tissue defects. Distant defects are challeng-ing for surgeons to save probable ischemic distal ends. Tissue expansion, especially in posterior part of supraclavicular, not only reinforces vasculature nourishment of flap and diminishes wound problem risks, but also makes flap thinner and more pliable to adjust defects.Conclusion:Supraclavicular artery flap` expansion on posterior area can help reach distally safer and reliable.
100 Telemedicine in Otolaryngology During COVID-19 Pandemic: Our Experience , Vikasdeep Gupta;Vaibhav Saini;Gagandeep Kaur and Ankur Mohan.
Objective:To study the feasibility and scope of telemedicine in otolaryngology in the COVID 19 pandemic and global lockdown.Methods: A retrospective study was performed in the otolaryngology department during COVID 19 pandemic at AIIMS Bathinda. Telemedicine consultation was set up to replace face to face consultation. Both audio and video consultation facility option was pro-vided to patients. The patient satisfaction survey was done to assess the satisfaction level of telemedicine during COVID 19 pandemic in otolaryngology patients. The patient had to register for audio or video consultation, after which the patient would receive a call from the concerned department on the next day on the allotted time. The time slot for each patient was 15 minutes. Consultations were performed by the senior otolaryngologist. The informed consent was taken from the patient. The study was approved by insti-tutional ethical committee.Results:The total of 95 patients enrolled for teleconsultation in the otolaryngology department during the period from April 2020 to August 2020. The most common age group range was 21-40 years. The male to female ratio was 1.2:1. Out of 95 patients, 58 patients had registered for audio teleconsultation and 37 patients for video teleconsultation. The most common subspeciality patients were throat and head and neck. The overall satisfaction rate was 89%.Conclusions:Telemedicine is useful for follow up patient and we can rely on telemedicine in these patients. It helped patients to reach health care specialist while reducing the exposure to both.
101 Primary Non Hodgkin’s Lymphoma of Glottis: A Diagnostic Dilemma , Shashikant Anil Pol;Aditi Mahajan;Reetu Kundu;Surinder K Singhal;Nitin Gupta.
Primary Non-Hodgkin’s lymphoma of the larynx is rare, accounting for less than 1% of all laryngeal neoplasms. Fewer than 100 cases have been reported in the literature. Early symptoms are nonspecific and subtle, so confirmation of the diagnosis is difficult thereby leading to a delay in management. We hereby present a case of a 30 year old male with Non Hodgkin’s lymphoma of larynx who presented with hoarseness as the only complaint. In this case, intra operative assessment and histological interpretation was critical, and formed the basis of correct management in the form of radiotherapy
102 Comparison of Envelope Perception between Syllabic and Dual Compression Hearing Aid Processed Kannada Chimeric Sentences , Devi Neelamegarajan1;Sridhar Sampath;Vinayagar PT.
Introduction:Temporal envelope cues and temporal fine structure cues are essential for perception of speech. However, tonal lan-guage employ more of TFS cues and non-tonal language employ envelope cues for perception. The native speakers of Kannada use envelope cues for speech perception. Perception might vary depending on the compression characteristics and the number of pro-cessing channels in hearing aid users. So, it is important to understand the effect of compression system and processing channels on perception of envelope cues. Objective: To compare the perception of envelope cues: across different frequency bands; between syllabic and dual compression, between an eight channel and sixteen channel hearing aids, using hearing aid processed Kannada chimeric sentences.Methods and Materials: Sentence identification task was carried out in thirty native adult Kannada speakers with normal hearing acuity. Stimuli used was hearing aid processed Kannada chimeric sentences prepared with standardised sentence identification test in the Kannada language through Hilbert transformation and processed using 2 hearing aids of eight and sixteen processing channels in syllabic and dual compression programs.Results:Perception of envelope cues were not significantly different using chimeric sentences processed using syllabic and dual compression system, where as it was significantly different while using chimeric sentence processed using 8 and 16 channel hearing aids.Conclusions:Dynamic characteristics of compression system such as fast and slow acting have no effect on perception of envelope cues in native Kannada speakers, whereas number of signal processing channels need to be considered while evaluating the percep-tion of envelope cues.
103 Post-infectious Lymphedema Can Cause Facial Paralysis , Salvatore Bühling.
Background: Lymphedema (LE) as well as facial palsy ́s (FP) are relatively common disease.FP can be divided into idiopathic FP (Bell ́s palsy) and secondary FP due to a determined reason like trauma. The most common reasons of secondary FP are metabolic disease, tumors, infections, neurological disorders, autoimmune disorders, trauma and surgi-cal interventions.LE is a high protein edema. The most common reasons for a secondary LE are lymphatic filariasis, irradiation and surgical inter-ventions.Report: A 51 year old male with uncontrolled diabetes mellitus and a hypersensitivity lung disease (HLD) presented with 3 days fever and cellulitis in his face. He developed a very extensive LE and becomes septic (in the cours, he needs pressors and intubation for airway protection). The rapid streptococcal test was positive.In the examination, we diagnosed then a dense, painless facial nerve palsy in all branches on the left (except his marginal branch).Conclusion: In our knowledge, this is the first publication which reports, that a LE causes a secondary FP. Due to the fact, that both LE and FP are not so rarely seen disorders, our goal is to sensitise other physicians about the possibility of a casual coherence between them; that may be of important relevance for the outcome of the patients.
104 COVID 19 Pandemic: A New Burden on Communication in Elderly , Somia Tawfik Mohamed Ali;Noura Essam Eldin Ammar.
The ongoing pandemic of coronavirus disease 2019 (COV-ID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is undoubtedly the defining global health crisis and the greatest challenge the world has faced since the World War II. . Actually, this serious health problem mandates lockdown and certain protective measures. These includes social distancing, self-isolation measures as well as use of facemasks. All these measures have negative impact on communication. For example, wearing Facemasks can hinder proper communication as the sounds be-come muffled. However, it is considered one of the most protec-tive measures as it guards against infection and keeps people safe. More than 50 countries mandate wearing masks in public.
105 Smartphone Apps for Hearing Surveillance During the COVID Pandemic , Yahya Ghaffar;Gauri Mankekar.
Telemedicine has become the preferred modality for providing healthcare during the COVID -19 pandemic. It has helped connect patients safely with their physicians to monitor their health. Telemedicine has its challenges. Technology, creativity and resourceful-ness is assisting to overcome them. Amongst Otorhinolaryngological specialties, treating Otology issues via telemedicine has been traditionally difficult. Here we discuss our experience incorporating Smartphone apps and video otoscopes in Otology telemedicine during the COVID pandemic.
106 Glomus Jugulare - A Rare Presentation , Siddam Revathi; L Sudarshan Reddy; M Mohan Reddy.
A case report on glomus jugulare from India.We present a case of a 15-year-old male, with 6 months history of tinnitus and progressive hearing loss, presented with facial nerve palsy (House-Brackmann V). Computed tomography scans demonstrated an enhancing soft tissue lesion with erosion of jugu-lar bulb, invasion of the petrous and tympanic bone, middle ear and vertical part of facial nerve with erosion of postero medial wall of left TM joint (type C2 of Fisch’s classification for GJT). Intraoperatively the mastoid part of the facial nerve was identified involved by tumour and needed to be resected. Inter positioning cable grafting with greater auricular nerve, harvested at the beginning of the surgery is done. Total tumour resection is done with a remarkable postoperative course. The patient also presented with improve-ment in facial nerve function after 6 months. The patient consented with publication of his images.
107 New Wave of Covid-19: Reinfection and Immunization , Luciana de Barros Correia Fontes; Maria da Conceição de Barros Correia;Kátia Maria Gonçalves Marques;Nayara Ferreira da Silva1, Marília Cleide Tenório Gomes;Amanda Caroline Oliveira Henriques Mendes;Rosa Maria Mariz de Melo Sales Marmhoud Coury;Denise Nóbrega Diniz;Criseuda Maria Benício Barros;Leonardo Bezerra Cavalcanti dos Santos;Niedje Siqueira de Lima.
This opinion is based on the experience in teleconsultancy of Covid-19, from the month of March until the present, in December of the year 2020. The world highlights the "new wave" of the pandemic caused by SARS-CoV-2 and, at the same time, there are reports of reinfection. With immunization processes being investigated and set in motion, many doubts and questions occur in this period of coexistence; some of those raised here
108 Knowledge on Cochlear Implants among Medical Students, Tanzania , Massawe Richard Enica1;Ntunaguzi Daudi;Ibrahim Abdul Hazali.
Background: Cochlear implantation is one of the most performed surgery worldwide currently to people mostly children with sensorineural hearing loss to solve the effects of severe to profound hearing loss and without this, these children would be left with deafness for life. Tanzania has also developed and started to perform cochlear implantation to children in 2017. Objective: The main aim of this study was to assess Knowledge on cochlear Implants among senior medical students and interns who are going to be the primary care providers and will be required to make proper diagnosis and referrals for children requiring cochlear implants to the right facilities for further management hence their knowledge is of great essence.Methodology: Descriptive cross sectional study was used, a structured questionnaire was used to collect data and Stratified random sampling method was used to get participants. Self-administered questionnaires was used for data collection and collected data was coded and analysed using IBM SPSS version 24.0.Results: In this study which involved 203 participants, we found that only 87.2% have ever heard about cochlear implants and only 80.2% knew that cochlear implants may restore hearing to the deaf and 11.3% did not know that children who received cochlear im-plant could learn spoken language also 35% of the participants did not know that cochlear implant is being done in Tanzania despite starting performing the surgery since 2017. More than half of the participants are knowledgeable to different candidacy criteria for cochlear implantation however only 23.2% of the participants knew that a child without a cochlear is not a candidate for cochlear implants. More than 90% of participants knew that Audiologist, Otolaryngologist and speech therapist are key members of cochlear implant team but only 65% knew that a social worker is also a member of the team. We also found that more than half of the partici-pants knew that infections, device failures, cerebral spinal fluid fistulas facial nerve paresis and cholesteatomas are complications associated with cochlear implantations. It was also found that there was an association between the university studied/studying and the level of knowledge, Majority of government owned university students having high knowledge while those of private owned having moderate knowledge.
109 Middle Ear Effusion in Preschool Children in Dar-es-Salaam, Tanzania , Enica Richard Massawe; Daudi Cheche Ntunaguzi;Ndeserua Moshi and Kassim Babu Mapondella.
Background: Otitis media with effusion is a common disorder in children, which may either resolve spontaneously or cause undesir-able complications especially if associated with persistent hearing loss.Otitis media with effusion contributes to hearing loss, poor speech acquisition and learning difficulties. There has not been any retrievable study done to show the magnitude of otitis media with effusion and its complication in our country.Aim: This study aimed at determining the prevalence of otitis media with effusion among preschool children in Kinondoni District, Dar es Salaam.Materials and Methods: This study was conducted in Kinondoni District, Dar es Salaam in Tanzania among 541 preschool children aged 2 to 6 years. Random sampling method was used. Otoscopic examination was done by the principal investigator using pneu-matic otoscope. Diagnosis of otitis media with effusion was reached by findings of the ear drum with exclusion of features of acute otitis media. Tympanometry was conducted by research assistant and type B curve was regarded as diagnostic for otitis media with effusion.EPI-INFO version 6.04d computer program was used to analyze the data and relationships were tested at 5% tolerable error.Results: Out of 541 preschool children screened, 24% had otitis media with effusion in one or both ears. Fifteen percent had bilat-eral otitis media with effusion while 4.8% had right and 4.3% had left otitis media with effusion respectively. Of the screened female children, 26.5% had otitis media with effusion which was slightly higher than males (21.7%). The prevalence of otitis media with effusion was higher (24.5%) among children aged 5 to 6 years as compared to prevalence of 22.5% among children aged 2-4 years. Both pneumatic otoscopy and tympanometry detected otitis media with effusion in 17.8% of children aged 2 to 4 years while 14.3% of children aged 5 to 6 years were detected by pneumatic otoscopy and 14.1% were detected by tympanometry.The pneumatic otoscopy was found to be as good as tympanometry in diagnosing otitis media with effusion and it’s sensitivity was found to be 97.7% and specificity was 99.5%.Conclusion: The overall prevalence of otitis media with effusion among preschool children in Kinondoni District in Dar es Salaam was noted to be high. The prevalence was higher among children aged 5 to 6 years and in females. Pneumatic otoscopy was as good as tympanometry in diagnosing otitis media with effusion.
110 The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients , Siti Nurfarhana Mohd Arif;Mawaddah Azman;Sharifa Ezat Wan Puteh; Nur Shahrina Mohd Zawawi;Abdullah Sani1 and Marina Mat Baki.
Objectives:1) to evaluate the reliability of measurements of maximum vocal intensity (maxVI), reading pitch range (RPR) and sing-ing pitch range (SPR); 2) to determine the parameters’ correlation with voice handicap index-10 (VHI-10); and 3) to compare the difference of the parameters between pathology and healthy group.Methods: This cross-sectional studythat was performed in a tertiary centre included 30 patients diagnosed with unilateral vocal fold palsy (UVFP) and 30 healthy volunteers (n = 60 participants). The participants’ voices were measured for maxVI (dB) using Sound Level Meter (SLM) at 100cm, and RPR and SPR (Hertz) using OperaVOX at 30cm distance, from lips. The phonation tasks were vowel /a/ at maximum loudness (maxVI), reading a standard passage (RPR) and glissando mode /a/ (SPR). The measurements were re-peated within 30 minutes interval. Voice handicap index-10 (VHI-10) was documented for all participants. The internal consistency of the measurements was evaluated using intraclass correlation (ICC). Correlation of parameters with VHI-10 was assessed with Spearman Correlation Coefficient. The comparison between two groups was done with Mann Whitney U Test. Results: The reliability of maxVI, RPR and SPR was substantial to excellent with ICC of 0.83 (0.7,0.89), 0.9 (0.94,0.97) and 0.62 (0.44, 0.61) respectively. There was a significant difference for maxVI and SPR between the UVFP and healthy volunteers (p < 0.01). MaxVI showed good significant negative correlation with VHI-10 (r -0.63, p < 0.05) whereas RPR and SPR were poorly correlated with VHI-10 (r = -0.126 and r = -0.28, p > 0.05). Conclusions: MaxVI showed good results depicted by its excellent reliability, ability to differentiate between UVFP and healthy volunteers and good correlation with VHI-10. Thus, MaxVI is may be a potential primary outcome measure in future clinical trials related to UVFP.
111 Primary Ciliary Dyskinesia with Structurally Normal Cilia: An Unusual Diagnosis , Hugo Marcos;Tiago Soares Santos;Paulo Gonçalves;Mário Sousab;Elsa Oliveira; Carlos Carvalho;Mikkel Christian Alanin.
Defects in cilia are associated with several human diseases. Chronic rhinosinusitis with nasal polyps is one of those diseases. Ultrastructural ciliary defects diagnosed by transmission electron microscopy are usually seen. Rarely are found patients who have structurally normal cilia with an abnormal ciliary function. We present 2 cases of 15-year-old and 13-year-old female patients with chronic rhinosinusitis with nasal polyps and primary ciliary dyskinesia with structurally normal cilia. Although they had structurally normal cilia at transmission electron microscopy, when analyzed for variation in ciliary beat axis and ciliary deviation, the results were compatible with primary ciliary dyskinesia
112 Lipoma of Tongue: A Common Lesion at an Uncommon Location , Sanika Kulkarni, Dinshaw Hormuzadi2, Jaydeep Pol, Himanshu Soni and Shivani S Desai
Though lipoma is a most common benign tumour its incidence in oral cavity is very rare. These lesions are usually slow growing and painless hence go unnoticed for years. Because of the rarity of this tumour, here we are discussing a case of very large and long standing lipoma of tongue and its surgical management.Keywords: Lingual Lipoma; Intraoral Lipoma; Wide Excision; Tongue Lipoma
113 Changes in the Color and Sensitivity of the Tongue in Adult Women After COVID-19 Treatment , Luciana de Barros Correia Fontes, Maria da Conceição de Barros Cor-reia, Kátia Maria Gonçalves Marques, Pedro Henrique Bezerra Fontes, Nayara Ferreira da Silva, Marília Cleide Tenório Gomes, Rita de Cássia Barreto Fernandes, Daniele Andrade da Cunha, Hilton Justino da Silva, Leonardo Bezerra Cavalcanti dos Santos and Niedje Siqueira de Lima
Objectives: to describe the changes in color and sensitivity of the tongue in adult women, in the period after the treatment of COVID-19 and explain the dental conduct for treatment. Case report: there was a request for dental evaluation by a public and re-ference University Hospital in the city of Recife, northeast of Brazil. The patient in question was a 33 years-old white female. There was a history of diagnosis and treatment for COVID-19, with antibiotic, antipyretic and medication for worms, with the complaint of much sensitivity and change in language. The physical examination showed gingivitis in the lower sextant, with spontaneous gingival bleeding and dark spots on the dorsum of the tongue, associated with increased discomfort in the region. It was observed that the patient did not receive any orientation about oral hygiene, even with the report of pain in this region. It was opted for the orientation of the hygienization, with the reinforcement of the cleanness of the tongue, cheeks with hydrogen peroxide or oxygenated water to 10 volumes and the reinforcement for the ingestion of vitamin C, beyond the control of the biofilm, for the treatment of the gingivitis in the anterior and inferior sextant. Conclusions: this report covers the control made in seven days, being the images referring to the third day after the guidelines. There was a change in the color of the tongue and sensibility, with regular ingestion of food and liquids. There was also an improvement in gingivitis, but control is necessary.Keywords: Oral Health; Tongue; Coronavirus Infection
114 The Mephitic Vascularity-Bacillary Angiomatosis , Anubha Bajaj
Bacillary angiomatosis is an uncommon, reactive vascular pro-liferation additionally denominated as “epithelioid angiomatosis”, engendered by miniature, gram- negative bacilli of Bartonella ge-nus especially Bartonella henselae and Bartonella quintana. Bacillary angiomatosis was initially scripted by Stoler., et al. in 1983 as an “atypical, subcutaneous infection associated with au-toimmune deficiency syndrome (AIDS)” [1]. The condition com-monly appears in subjects infected with human immune deficiency virus (HIV) although immunocompromised, non HIV infected or immune competent individuals are also incriminated
115 CSOM with Sclerotic Mastoids: Does Cortical Mastoidectomy Offer any Benefit Vis a Vis Graft Uptake and/or Hearing Outcome , Tsewang Thinles, Shahid Rasool, Alyuza Saman, Ratna Priya
Background: Chronic suppurative otitis media (CSOM) without cholesteatoma is a common diagnosis in otologic practice. Although opinions vary regarding the definition of chronic otitis media, most consider middle ear disease to be chronic if present for longer than 6 weeks. In cases of an actively discharging ear, it has been shown that mastoid exenteration frequently, but not always results in disease resolution. In quiescent chronic otitis media studies have shown that good outcomes are possible, irrespective of whether mastoidectomy was added to tympanoplasty or not.Objectives: Does mastoidectomy improves hearing and/or graft uptake rates in CSOM with sclerotic mastoids.Procedure: This is a prospective comparative study were patients with safe type of CSOM with dry ear for 1 month and having ra-diological evidence of mastoid sclerosis were included. Patients were divided randomly into two Group A and B with 32 and 40 cases respectively. Group A Patients underwent type 1 tympanoplasty with cortical mastoidectomy. While as Group B patients were offered standard type 1 tympanoplasty only.Results: The observations with respect to post-operative graft uptake rates in two groups under comparative study were quite simi-lar and comparable with p value of 0.873. Although the graft uptake rate in group A (84%) was seen on higher side compared to that in group B (80%). There was significant improvement in post-operative AB Gap in both groups with p value of < 0.0001. Moreover, no significant statistical difference was noted in post-operative AB Gap between the two groups at an average follow up period of 6 1/2 months. Conclusion: We concluded that mastoidectomy hardly offers any additional benefit with respect to graft uptake and hearing im-prove ment in sclerotic mastoids. So, the author doesn’t recommend the routine addition of mastoidectomy for sclerotic mastoid unless there are other compelling indications.Keywords: Sclerotic Mastoid; CSOM; Tympanoplasty; Cortical Mastoidectomy
116 Slight Improvement of Symptoms in a Patient with Otosclerosis by Occlusal Modification: A Case Report , Kengo Torii
The relationship between some aural symptoms and dental occlusion have been reported, However, the relationship between oto-sclerosis and occlusion has not yet been reported. Occlusal improvement was achieved using the occlusal position correcting therapy on a patient with otosclerosis. Occlusal analysis was performed by mounting dental models on an articulator and identifying a pre-mature occlusal contact on the right second molar artificial teeth and a deviation of the habitual occlusal position from the muscular occlusal position. Occlusal modification was performed to make the habitual occlusal position coincide with the muscular contact position. The persistent tinnitus on the right ear became intermittent. From time to time, the ringing sound of the bell appeared. And the hearing impairment on the right ear was not improved.Keywords: Habitual Occlusal Position; Muscular Occlusal Position; Otosclerosis; Tinnitus
117 Foreign Body in the External Auditory Canal. Case Report , Mahomed Sidique Abdul Cadar Dadá, Abdul Habib Mahomed Dadá2
Foreign bodies in the natural orifices of the head and neck is a frequent problem observed in otorhinolaryngology consultations and emergency services at hospitals and private clinics. Foreign bodies are introduced intentionally or accidentally. In the present clinical case, we discuss the story of a 5-year-old child who introduced bicycle spoke nipple in to the ear. Extraction was performed by washing, without any complications.It is a rare and unusual object. Hence the importance of taking into account all objects existing in the home that can potentially become foreign bodies, especially if there is a car or bicycle repair site in the house. Never leave small objects accessible to children. Always bear in mind that any object, however small, deserves the child's curiosity and potentially will end up in one of the head and neck holes.Keywords: Foreign Body; External Auditory Canal; Ear
118 Tongue Lipoma: Rare Location for a Tumor , Casas Ocando Julio J
Epithelial tumors have predominance in the tongue but it is an uncommon location for lipoma, tumor of mesenchymal origin, be-nign, asymptomatic slow-growing, soft tissue neoplasm of mature adipocytes, that can be sessile or pediculated, single or lobed and surrounded by a thin fibrous capsule [1,2], rarely recurs after sur-gical treatment [2,3].
119 Supervision of Hospitals and Healthcare Centers during COVID-19 , Mahdieh Motie,  Reza Dehnavieh, Khalil Kalavani
COVID-19 pandemic is a major challenge affecting the health systems of all countries in the world and health workers are strug-gling with the virus for a long time and are providing health ser-vices every day. Although they may feel tired and worn out, hospi-tals and health care organizations around the world are doing their best to support the front-line forces. Due to the corona pandemic, there is excessive work pressure on health workers, and managers must take appropriate measures to support them in various ways
120 Utility of Ultrasound and Colour Doppler in Evaluation of Pediatric Vascular Lesions in the Neck , Rajesh C Kamble, Alpana N Joshi, Pravin Mestry
Vascular lesion is an all-encompassing term used to describe a wide range of conditions consisting of an abnormal number, struc-ture, or position of blood vessels. Keywords: Ultrasound; Vascular Lesions in Neck; Pediatric Vascular Neck Pathologies
121 Impact of Systemic Arterial Hypertension on Cochlear Function , José Luis Treviño-González, Germán A Soto-Galindo, Félix Maldonado-Chapa
Background: Systemic arterial hypertension is a highly prevalent disease that has been associated with cochlear impairment. Aims: The purpose of our study is to evaluate hearing thresholds and to identify the presence of tinnitus and its severity in patients with hypertension and compare them with a healthy control group.Methods: A cross-sectional and comparative study was performed, comparing 131 patients with hypertension to 331 healthy con-trols. Subjects underwent pure tone audiometry to evaluate hearing thresholds for low, mid, and high frequencies and speech audi-ometry. All subjects were evaluated for the presence of tinnitus. Tinnitus handicap index was completed to determine the severity and impact of tinnitus on quality of life. Results: In the hypertension group mean hearing thresholds in low frequencies were 18.8 dB (± 8.06), 21.2 dB (± 9.72) in mid fre-quencies, and 35.9 dB (± 17.42) in high frequencies; for which a significant statistical increase was shown in low frequencies (p = 0.0001), mid frequencies (p = 0.0003), and high frequencies (p = 0.0001) compared with the control group. A significant difference (p = 0.0001) was found in the prevalence of tinnitus of hypertension patients (80%) compared with control subjects (17%). We observed a mean score 15.98 (± 17.67) in the tinnitus handicap index of patients with hypertension showing a significant difference compared to a mean score 4.55 (± 1.51) in the control group (p = 0.001). Conclusion: A significant increase in hearing thresholds, prevalence, and severity of tinnitus in patients with hypertension was shown compared to a healthy control group. This study consolidates an association between systemic arterial hypertension and cochlear impairment.Keywords: Systemic Arterial Hypertension; Hearing Loss; Tinnitus; Audiometry
122 Unknown Mystery of Microchimerism , Osman Demirhan, Bülent Demirbek
Chimera is defined as a monsterous made up of parts of multiple animals in mythology. Today, the term chimera is used in the fields of genetics and molecular biology to describe living entities that emerge or are created as mixtures of separate entities. There-fore, microchimerism (Mc) is defined by the presence in an individual of a small number of cells or DNA belonging to a genetically dif-ferent individual. Pregnancy is the most common and natural cause of chimerism and occurs by the bi-directional passage of hemato-poietic cells through the placenta between mother and fetus. Bidirectional cell exchange between pregnant woman and fetus during pregnancy potentially leads to microchimerism (Mc) in both the mother and the fetus. Therefore, we are all born as microchimeric.Keywords: Microchimerism; Fetal-Maternal Microchimeric Cells; Autoimmune Diseases; Viral Disease; Canser; Jung-Archetypal
123 A Rare Case of Cowden Syndrome Presenting as Multinodular Goitre , Hari Shankar Sharma, Shivali Sharma
Screening for cancer associated with syndromes is a very common practice nowadays. Nodular Thyroid disease is very uncommon in childhood and adolescence when their family is having history of nodular thyroid disease which has been diagnosed with benign or malignant disease. Keywords: Cowden Syndrome; Thyroid Disease; Cancer; PTEN Gene
124 Use of Weber Ferguson Approach: An Effective Option to Reduce Recurrent Maxillary Fibrous Dysplasia , Emrah Kagan Yasar, Can Ilker Demir, Ceyhun Uzun and Murat Sahin Alagoz
Fibrous dysplasia (FD) is a progressive but generally benign disease in which normal medullary bone is replaced by abnormal fibro-osseous tissue. The Weber Ferguson (WF) incision can be used for wider resection due to recurrent fibrous dysplasia affecting the right maxillary bone in a patient with a previous history of reduction surgery with an intra-oral approach. The WF incision is an alternative surgical approach option in cases in which an intraoral approach will be inadequate in patients with recurring maxillary FD sufficiently large to affect social life.Keywords: Fibrous Dysplasia; Infraorbital; Maxilla; Nerve Repair; The Weber-Ferguson Incision
125 Nasal Tip Deprojection- An Incremental Approach , Nanda Vipul, Agarwal Avinash, Sharma Manik
Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration of nasal tip is technically challenging as every small manoeuvre may lead to dramatic outcomes. There is paucity of well-defined guidelines for sequence of steps to de-project nasal tip. We propose an incremental approach for deprojection of nasal tip. It emphasises on re assessment of tip after each manoeuvre to attain a final pleasing outcome.We analysed 60 patients of true over projected nasal tip over a period of eight years. In all patients sequence of surgical steps were the same as described. In the process, when desired tip de projection was achieved, further steps were not performed.Keywords: Rhinoplasty; Nasal Tip; Manoeuvre
126 Nasal Foreign Body Removal by Open Rhinoplasty Approach - An Unusual Case Report , Priyajeet Panigrahi, Tapan Kumar Sahoo
Nasal foreign bodies are very common in children but very rare in adults unless self inflicted. Following a road traffic accident foreign bodies like tiny stone particles and dust even small metallic foreign bodies can enter the wound site and cause inflammatory reaction. Identification and removal of any foreign body is always necessary. Loose foreign bodies are always dangerous because it may travel to posterior nasal space and there is high chance of aspiration. This is a case where a tooth impacted inside nose since 3 months following a road traffic accident. Foreign body was successfully removed by an open rhinoplasty approach. Open rhinoplasty approach is a safe and very effective way of foreign body removal in cases where a conventional endoscopic approach is not feasible. Keywords: Nasal Foreign Bodies; Inflammatory Reaction; Open Rhinoplasty Approach
127 Future of Dentistry in Covid 19 , Amil Sharma
COVID-19 or normally known as a corona virus disease has already been in a pandemic situation which almost grabs many countries in the world. Its outbreak is still at large and even grasp-ing medical professionals too. Corona virus disease or simply Co-vid-19 caused by SARS-CoV-2 infection that affects our respiratory tract i.e. Nose, throat sinus. It can spread if a person came in con-tact with an infected person and infection may range up to mild, moderate and severe. Patients with systematic problems are af-fected by Covid-19. Dental Surgeons uses many instruments like air rotor, hand pieces and ultrasonic scalars with high speed so they have in build water supply to cool it down
128 The Oleaginous Conglomerate-Multiple Symmetric Lipomatosis , Anubha Bajaj
Multiple symmetric lipomatosis (MSL) is an exceptional disor-der of adipose tissue metabolism and lipid storage. The condition was initially scripted by Sir Benjamin Brodie in 1846 and is ad-ditionally designated as Madelung’s disease, Launois-Bensaude syndrome or benign symmetric lipomatosis [1]
129 The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients , Siti Nurfarhana Mohd Arif, Mawaddah Azman, Sharifa Ezat Wan Puteh, Nur Shahrina Mohd Zawawi, Abdullah Sani and Marina Mat Baki
Objectives: 1) to evaluate the reliability of measurements of maximum vocal intensity (maxVI), reading pitch range (RPR) and sing-ing pitch range (SPR); 2) to determine the parameters’ correlation with voice handicap index-10 (VHI-10); and 3) to compare the difference of the parameters between pathology and healthy group.Methods: This cross-sectional study that was performed in a tertiary centre included 30 patients diagnosed with unilateral vocal fold palsy (UVFP) and 30 healthy volunteers (n = 60 participants). The participants’ voices were measured for maxVI (dB) using Sound Level Meter (SLM) at 100 cm and RPR and SPR (Hertz) using OperaVOX at 30 cm distance, from lips. The phonation tasks were vowel /a/ at maximum loudness (maxVI), reading a standard passage (RPR) and glissando mode /a/ (SPR). The measurements were re-peated within 30 minutes interval. Voice handicap index-10 (VHI-10) was documented for all participants. The internal consistency of the measurements was evaluated using intraclass correlation (ICC). Correlation of parameters with VHI-10 was assessed with Spearman Correlation Coefficient. The comparison between two groups was done with Mann Whitney U Test. Results: The reliability of maxVI, RPR and SPR was substantial to excellent with ICC of 0.83 (0.7, 0.89), 0.9 (0.94, 0.97) and 0.62 (0.44, 0.61) respectively. There was a significant difference for maxVI and SPR between the UVFP and healthy volunteers (p < 0.01). MaxVI showed good significant negative correlation with VHI-10 (r -0.63, p < 0.05) whereas RPR and SPR were poorly correlated with VHI-10 (r = -0.126 and r = -0.28, p > 0.05). Conclusion: MaxVI showed good results depicted by its excellent reliability, ability to differentiate between UVFP and healthy volun-teers and good correlation with VHI-10. Thus, MaxVI is may be a potential primary outcome measure in future clinical trials related to UVFP
130 18F-FDG PET/CT in Identifying Primary Site in Patients with Neck Secondaries: A Cross Sectional Study , Darwin Kaushal, Suresh Chandra Sharma, Rakesh Kumar, Bidhu Kalyan Mohanti, Ashu Seith Bhalla and Nithin Prakasan Nair
Purpose: The detection of the primary site in patients with carcinoma unknown primary neck is always a challenge. This study was conducted to assess the role of 18F-FDG PET/CT in detecting the primary in patients with neck secondaries. This study also aimed to compare its diagnostic sensitivity with computed tomography and triple endoscopy.Materials and Methods: We prospectively evaluated thirty two patients of carcinoma of unknown primary who presented with cervical lymphadenopathy. Inclusion criteria were all patients who had a fine-needle aspiration of cervical lymph node suggestive of squamous cell carcinoma without clinically detectable primary site. We did a clinical and radiological evaluation for all patients. All patients were subjected to further assessment by a triple endoscopy and 18F-FDG PET/CT. Following 18F-FDG PET/CT, we took a biopsy from the suspicious site in all patients. The biopsy reports were collected.Results: The primary detection rate was 18.8%. With the help of PET CT, biopsy confirmed primary site was detected in 6 patients. The sensitivity, specificity, positive predictive value, negative predictive value of PET-CT were 100%, 34.6%, 26.1%, 100% respec-tively. Conclusion: 18F-FDG PET/CT has higher sensitivity, detection rate and negative predictive value as compared to computed tomog-raphy and triple endoscopy
131 COVID 19 Battle: The Evolving Enemy , Arya Ajith
As the month of April comes to a debilitating end, there are two extremes of numbers seen. Extremely high (and still counting) number of COVID-19 cases but low number of provisions for the same. The catastrophic second wave of the COVID 19 infection has devastated India. Despite having a strong response at the onset of the COVID 19 pandemic, India now has the World’s fastest growing outbreak of the corona virus infection. The cataclysmic nightmare is rapidly sliding into a devastating crisis, with hospitals exceeding their capacity and with paralyzing shortage of oxygen and drugs.
132 Skin Prick Test - A Useful Tool in Diagnosis of Unexpected Triggers and Management of Allergy , Dr Prashant Kewle, Dr Amrapali Keny-Pawar
The prevalence of allergy is on the rise with increase in urbanisation and environmental pollution. Skin Prick Test serves as a useful tool for detecting the allergens that trigger allergy in atopic individuals. The Skin Prick Test can be done with a few allergens (3 or 4 substances) or sometimes as many as 40 to 50 substances. In this paper, we have emphasized the importance of performing Skin Prick Test with more numbers of allergens while dealing with a patient of allergy during the management of allergic rhinitis, asthma or urticaria. We should bear in mind that a significant number of these patients also suffer from Food Allergy Syndrome, which is often missed and underdiagnosed, if the SPT is done with fewer number of allergens.
133 Masks, Masking the Facial Expression and Lip Reading: Added Burden for Hearing Impaired during COVID-19 , Anjali Singal
The confirmed cases of COVID-19 are increasing in India even after more than a year of the pandemic (as of April 19, 2021). The standard preventive measures to fight against the virus are to wear face mask, social distancing, frequent hand washing or sanitizing and to get vaccinated, if eligible. The masks act as a physical bar-rier to guard you and others from the infection. Un-doubtfully wearing a mask, especially if in close proximity to others, is im-perative to break the chain and contain the spread of COVID-19.
134 The Maladjusted Crystallization-Non Ossifying Fibroma , Anubha Bajaj
Non ossifying fibroma (NOF) is a benign neoplasm of fibrous tissue origin appearing on account of dysfunctional ossification. The neoplasm is additionally designated as metaphyseal fibrous defect, non-osteogenic fibroma, cortical desmoid, fibrous cortical defect, fibromatosis or fibroxanthoma.
135 Case Series-Intraparotid Facial Nerve Schwannoma: Our Experience in 5 Cases , Nitin Gupta, Shashikant Anil Pol, Surinder K Singhal, Himanshu Chhagan Bayad, Ranjeev Bhagat, Arjun Dass and Himani Gupta
Intraparotid Facial Nerve Schwannoma is an exceedingly rare tumor of head and neck region. It forms about 0.5% - 1.2% of all parotid tumors. It is neuroectodermal in origin. Facial nerve schwannomas are benign, encapsulated, slow growing tumours that arise from nerve sheath. Most common presenting complaint is unilateral facial swelling though facial paralysis is seen in few of the patients. Fine needle aspiration cytology (FNAC) and radiology play a key role in preoperative diagnosis. Treatment of choice for fa-cial nerve schwannomas is complete surgical excision. Here we are reporting 5 cases of facial nerve schwannomas which lies within the parotid gland region. All the patients presented with unilateral facial swelling from the year 2017 to 2020. Clinical features, diagnosis and management of these cases are discussed here. We recommend that before going for excision, patient should be made aware of the possible functional facial deficit and as per the patient’s priority, decision of excision should be made. After complete excision, recurrence rate was found to be extremely low. Usually, post-operative functional deficit recovers almost completely with physiotherapy.
136 Polymorphous Low-Grade Adenocarcinoma: A Case Report , Isadora Kamila Oliveira Silva1, Marina Siqueira Teixeira1, Victoria Dias de Miranda Paula Barroso1, Alessandra Oliveira Ferrari Gomes2, Silvia Paula de Oliveira3 and Luisa Aguirre Buexm
Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm featuring low aggressiveness and almost exclusively originated from minor salivary glands. A case of PLGA is reported in an 81-year-old female patient who attended the stomatology clinic reporting an increase in volume of palate. Intraoral examination revealed a tumor on the right posterior palate, hard in consis-tency and painless. Radiographic examination didn't reveal abnormalities. An incisional biopsy was performed with histopathologic diagnosis of salivary gland malignant neoplasm. Immunohistochemically the tumor cells were positive for EMA, CEA, p63, CK14, vimentin, S-100 protein and Ki-67 (< 1%), but negative for smooth muscle actin and GFAP. The patient underwent surgery with tumor-free margins, confirming PLGA. An obturator prosthesis was placed after surgery. PLGA is a slow-growing, distinct, uncommon neoplasm of the minor salivary glands. Because it is characterized by a diverse morphologic pattern that resembles adenoid cystic carcinoma or pleomorphic adenoma, the initial diagnosis is usually inconclusive.
137 Facial Palsy: The Right Time for the Right Choice , Della Monaca M, Giorgio Barbera, Andrea Cassoni, Andrea Battisti, Paolo Priore, Ingrid Raponi*, Valentina Terenzi, Filippo Giovannetti and Valentino Valentini
Aim: The aim of this study is to propose our experience and our protocol in post-operative facial palsy. Methods: A retrospective study about 32 patients was done. Timing of the palsy onset, surgical indications and the results using Facegram were analyzed.Results: The mean improvement for acute palsy evaluate with Facegram analysis of corner of the mouth excursion during smile was 41,30%. In the mid-term paralysis the measured improvement was 29,12%. Finally in the long - term facial palsy treated with func-tioning muscle transplantation was 34,30%.Conclusion: Facial nerve reconstruction should be addressed routinely in every patient who undergoes facial nerve resection or develop palsy after otologic or brain surgery.
138 Sudden Sensorineural Hearing Loss: An Updated Review , José Luis Treviño-González PhD MD*, Felix Maldonado MD, Germán A. Soto-Galindo MD, Jesús Eduardo Hernández de León MDa, Laura Lisset Reyes Suárez MDa
Sudden sensorineural deafness is defined as a hearing loss greater than 30 dB in 3 contiguous frequencies of pure tones that occur within 72 hours. It is a rare but disabling entity, affecting approximately 5 - 27 people per 100,000 globally per year. The etiology is identified only in a few cases, being a viral infection the most associated cause. The diagnosis is based primarily on the medical history, physical examination, and pure tone audiometry. The mainstay of treatment is corticosteroids, either systemic or intratympanic. This treatment can be accompanied by hyperbaric oxygen therapy to improve the response. For the follow-up, serial audiometric studies are suggested at the end of the treatment and six months, in search of residual hearing loss.We examined the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment of sudden sensorineural hearing loss to provide a comprehensive review on this topic to improve the understanding of this entity among clinicians.
139 Quality of Music Amplified by Hearing Aids , Archisman Shubhadarshan1 and Sushmit Mishra
Hearing aids are known to produce deleterious effect on music perception. This study explored how music perception through hearing aids can be improved. The recorded samples were rated subjectively by three groups of adult listeners. Group 1 consisted of 15 non-musicians, Group 2 included 15 professional singers and Group 3 comprised of 10 instrumentalists. The digital hearing aids were programmed for a flat 50 dB HL hearing loss. In this experiment, four-channelled (HA A) and fifteen- channelled (HA B) hearing aids were used. The knee-points of the hearing aids were set at default setting and at the highest possible setting. The noise reduction system and feedback management system were either turned off or on. A total of seven music samples processed through hearing aids were recorded along with the original sample using the same set up. The subjects rated all these music samples on a five-point perceptual rating scale that was relevant to music. Furthermore, the music samples were evaluated objectively by using the PRAAT software. In every parameter of perceptual analysis, it was observed that the highest rating was given to the original music sample followed by the music sample recorded through HA B with knee-point high, signal processing off and HA A with knee-point high, with signal processing off, respectively. The objective analysis results were similar to subjective analysis. This study demonstrated that a multi-channel hearing aid with knee-point set high and signal processing turned off provided the best representation of original music sample which is in agreement with a previous study.
140 Role of Drug Induced Sleep Endoscopy in Diagnosing the Site and Severity of Obstruction in Patients with Obstructive Sleep Apnoea , Aditi Mahajan1* and Susan K Sebastian
Introduction: The surgical management of Obstructive sleep apnoea (OSA) is based on the site and severity of obstruction of upper airway. The present study has evaluated these factors by performing a preoperative drug induced sleep endoscopy. The study aimed at diagnosing the site of obstruction in patients with obstructive sleep apnoea symptoms by drug induced sleep endoscopy and their relation to obstructive sleep apnoea syndrome severity.Materials and Methods: The study was conducted on 30 patients aged between 12 - 65 years, presenting with symptoms of obstruc-tive sleep apnoea. All patients underwent drug induced sleep endoscopy in operation theatre under propofol sedation.Result: In our study the sleep endoscopy findings revealed multilevel obstruction in 90% patients with maximum obstruction seen at retropalatal site. All 30 patients had varying degrees of retropalatal obstruction. Hypopharyngeal obstruction was seen in 83.33%. Next common site of obstruction in patients was the base of tongue, causing obstruction in 50% of the patients. Least common sites were the nose/nasopharynx and larynx. In larynx, epiglottis was the common site of obstruction.Conclusion: Drug Induced Sleep Endoscopy is a useful tool for the preoperative assessment and surgical planning OSA patients un-dergoing surgery management.
141 Clinical Presentation of Two Patients with Marjolin’s Ulcer Presenting in an Area of Previously Burned Skin: A Case Report , Marko Barić
Background: Marjolin's ulcer (MU) refers to an aggressive ulcerating squamous cell carcinoma (SCC) presenting in an area of previ-ously traumatized, chronically inflamed, or scarred skin. They usually develop in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention or burn wounds which never healed completely over years and the unstable post-burned scars. Lower limbs represent the most frequently affected body parts. Treatment is usually surgi-cal, with a wide excision of the lesion; typically, a 2 - 5 cm margin all around is required. Despite best efforts, the overall mortality is reported to be 21%. The aim of this case report was to present two of our patients suffering from mistreated and misdiagnosed Mar-jolin’s ulcer, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Treatment of both pa-tients was surgical and radical, whereas in the first patient, high femoral amputation with the stump reconstruction was performed. In the second patient, after a radical excision in sano and an extirpation of supraclavicular lymph nodes, a defect was reconstructed with rotational pedicled island myocutaneous latissimus dorsi flap. Conclusion: Reconstructive surgery provided a dramatic cosmetic improvement with significant psychosocial benefit. Unfortunate-ly, high-grade tumours have significantly high amount of recurrence and positive lymph node metastases, so repeated surgical pro-cedures may be required. Keywords: Marjolin’s Ulcer; Malignant Degeneration; Post-Burned Scars and Wounds; Squamous Cell Carcinoma; Full Thickness Skin Burns; Healing by Secondary Intention
142 Is it Necessary to Delay the Surgery for Patients who have had Covid-19? , Luis Alejandro Boccalatte
As part of the Review Board at Acta Scientific Otolaryngology® I would like to share my experience as National Lead in Argentina in this huge study. I started joining the main group, which is located in the United Kingdom, as collaborator in April. The first two stud-ies were called “COVIDSurg” the first one and “COVIDSurg-Cancer” the second one. Both Surg and Cancer studies have several publica-tions and huge impact in the surgical community [1,2]. Due to the number of patients that Argentina had enrolled, in August 2020 the main group in the UK invited me to take part in this project as national lead in my country. Also, I was designated a member of the dissemination committee in order to establish the protocol in Ar-gentina and contribute to the release into the scientific community
143 Critical Issues and Challenges in Conducting Clinical Trial during the Covid-19 Pandemic , Shehnaz Kantharia
he COVID-19 pandemic has an ongoing impact on the conduct of clinical trials across the world and India is no exception. The dis-ease has the potential to impact the scientific integrity and patient safety of ongoing trials. It has also affected the trial patient recruit-ment and retention. This may be due to several reasons like self-isolation/quarantine by patients and study site personnel, travel restriction across various districts of a state or interstate travel and also blocked access to Clinical trial sites in hospitals which may have been converted to Covid Care centres.
144 COVID19 and Epistaxis , Casas Ocando Julio
Cases of pneumonia of unknown origin caused by a new coro-navirus, SARS-CoV-2, were detected, in the Chinese city of Wuhan in December 2019, it has evolved rapidly into a public health crisis and the epidemic is declared on January 31, 2020, by the World Health Organization (WHO) and a pandemic on March 11 because has spread exponentially worldwide [1]
145 Headache as a Presenting Symptom in the Field of Otolaryngology , Haider Alsarhan
Headache as a chief complaint usually raises the thinking of the otolaryngologists to acute or chronic sinusitis or other nasal ENT problems; Although that way of concrete thinking is not wrong, it is very important for the otolaryngologist to be more open-minded and think as much as possible as a physician rather than otolaryn-gologist. A simple review of a sample of the literature of the causes of the headache can show a long list of causes that is related to dif-ferent specialties other than otolaryngology including neurology, neuro-surgery, ophthalmology, pharmacology, toxins, allergy and emergency medicine... etc. Zara M Patel., et a
146 Tuberculous Otitis Media - A Case Report , Swetha Chevula, Vani Padmasri M, Karuna N, Srivani N andCaptain L Sudarshan Reddy
Objective: To publish a rare case of tuberculous otitis media in an 18 year old male patient.Methods: An 18-year old male presenting with bilateral hard of hearing since 9 months was evaluated thoroughly by clinical exami-nation, hematological, radiological and histopathological evaluation.Results: Clinical examination revealed a single pinkish polypoidal mass with granulations occupying the right external auditory canal. Hematological investigations were within normal limits. Sputum for AFB was positive for Mycobacterium tuberculosis. Radio-logical evaluation with computed tomography showed soft tissue density in the bilateral prussack’s space and the epitympanum with erosion of the scutum. Biopsy was taken from the right aural polyp and the patient was managed conservatively. Histopathological examination showed squamous epithelium lining with sub-epithelium, showing areas of caseous necrosis surrounded by epithelioid cell clusters, lymphocytes and plasma cells along with dense neutrophil collection, karyorrhectic debris and areas of hemorrhage with few multinucleate giant cells. With all the above evaluations, diagnosis was concluded as tuberculous otitis media.Conclusion: It is a rare case presentation of Tuberculous otitis media.
147 Non-odontogenic Sinonasal-induced Toothache; a Communication Bridge Between Dentistry and Otolaryngology , Behzad Cheshmi*
The common innervation by maxillary division V2 of the tri-geminal nerve and anatomical proximity of maxillary teeth, maxil-lary sinuses and the anterior two-thirds of the nose can sometimes confuse clinicians from different disciplines for the correct diag-nosis of pain etiology in these areas. More specifically, differentia-tion of odontogenic pain, particularly odontogenic pain associated with maxillary teeth, from the pain associated with maxillary sinus problems (such as sinusitis) and nasal cavity problems (such as nasal vestibulitis) is sometimes misinterpreted by clinicians in the field of otolaryngology as well as dentistry.
148 Ear Nose Throat Lesions: Role of Imaging in Day to Day Clinical Practice , Rajesh C Kamble
It gives me immense pleasure to write this guest editorial for this upcoming April issue of Otorhinolaryngology journal.Being a radiologist and sonologist, ENT diseases have always come in my day to day practice either for CT, MRI imaging or for neck evaluation by ultrasound
149 Otorhinolaryngology Department during COVID-19 Scenario , Kshitija R Pathak, Rahul Khandekar, Manisha Maske and Santosh Jadhav
Purpose of this article is to give a gross idea that how COVID pandemic has affected the Otorhinolaryngology department in last few months and how we have adopted new practices in ENT OPD. This study consists of general presentation of patients coming to investigator in ENT OPD, detection rate of RAT and RTPCR tests and how we have modified our OPD setup accordingly. Also, we have described about the general measures that were taken during this study period which was from May 2020 to February 2021 in Dr. Vaishampayan Memorial Government Medical College and Ashwini Rural Medical College, Hospital and Research Center, Solapur. Keywords: COVID-19; URTI; Detection Rate; Anosmia
150 A Paradoxical Intruder Disfiguring the Face: Nasal Benign Fibrous Histiocytoma , BP Belaldavar, Rajesh Radhakrishna Havaldar, Vijayalaxmi M Dhorigol, Kavya Garg and Sneha A Sankaran
Benign fibrous histiocytoma is an uncommon presentation in the head and neck region. Composing of fibrous and histiocytic elements, these tumor are known to recur in almost a third of the cases if not excised completely. We hereby report a case of Benign Fibrous Histiocytoma (BFH) of the nasal dorsum completely removed by external approach. Although clinically the possibility of this diagnosis was not suspected, the procedure was tailor made right from the incision to excise the lesion in toto leading to no residual tumor or any morbidity. Knowledge of the possibilities of rare pathologies presenting as benign cysts should not be ignored in the head and neck. Keywords:Benign Fibrous Histiocytoma; Nose; Head and Neck
151 Inflammatory Myofibroblastic Tumor in a Known Case of Squamous Cell Carcinoma of Same Site - A Rare Case Report with Review of Literature , Srinitya Mulukutla, Shubhra Sharma, Sachin Wani, Hiral Shah and Ankit Shah
Background: Inflammatory myofibroblastic tumor is a rare and distinct disease entity comprising of myofibroblastic cells with in-flammatory infiltrate. It was first described in the lungs in 1939 and since then few reports have been made of its occurrence in the oral cavity. As it clinically and radiologically mimics a malignant lesion, the correct diagnosis is imperative to avoid radical treatment.Methods: We describe a case of 44 year male with a significant past history of squamous cell carcinoma of buccal mucosa, presenting with Inflammatory myofibroblastic tumor arising from same site. Patient presented with a solitary, well circumscribed lesion arising from buccal mucosa and gingival sulcus. Results: Final histopathology was suggestive of inflammatory myofibroblastic tumor showing compact proliferation of spindle cells arranged in a storiform pattern, with predominantly lymphoplasmacytic cells infiltration.Conclusion: Inflammatory myofibroblastic tumor can be accurately diagnosed with thorough understanding of histology and im-mune profiling which avoids unnecessary and extensive treatment protocols. No other case with a previous history of Squamous cell carcinoma of same site has been reported in literature.Keywords:Buccal Mucosa; Inflammatory Myofibroblastic Tumor; Oral Squamous Cell Carcinoma
152 Degree of Satisfaction among Postlingual Cochlear Implant Users in Oman , Naif Ali Al-Shashai, Noraidah Binti Ismail  and Marina L Alisaputri
Background and Objectives: The reliability of cochlear implant in aural rehabilitation has been reported in numerous medical and healthcare related journals and its implementation are widely seen in many rehabilitation centers. However, the use of cochlear im-plants can be affected by the satisfaction of cochlear implant users. In addition, there is little or no data on the satisfaction of cochlear implant user in Oman in the literature. Hence this research considers conducting the study to find out the post-cochlear implantation satisfaction of postlingual Omani adult and adolescent users. Subjects and Methods: The number of participants in this study was 21 (12 males and 9 females) and their age ranges from 15 years to 65 years. An Arabic version (back-to-back translated) of Satisfaction with Amplification in Daily Life (SADL) Questionnaire was used in the study to estimate the participants’ satisfaction and was correlated with the participants’ results of speech perception tests. Results: All participants with the exception of one were satisfied as obtained from the SADL questionnaire. There was a significant correlation between the outcomes of speech perception tests with visual clues and the overall score of the SADL questionnaire (r = 0.522) and it is significant at α ≤ 0.05. Conclusion: The results produced in this research are positive, further studies with a larger sample size are needed to generalize the findings.Keywords: Satisfaction; Cochlear Implant; Oman; Satisfaction with Amplification in Daily Life
153 Versatility of Local Rotational Flaps on the Management of Traumatic Facial Injuries: A Case Report and Review of the Literature , Nicolás Solano, Ejusmar Rivera, Anixa Álvarez, Ana Villarroel and Carlos Medina
The reconstruction of traumatic facial injuries of soft tissues represents a challenge for the surgeons due to its anatomical com-plexity. The use of local rotational flaps in these defects is a great advantage since it allows the restoration of the facial contour, leaving a scar in prudent areas with proper planning; it can be performed without complications and with minor surgical time. The objective of the present study was to show the use of the local rotational flap as a treatment of traumatic facial injuries by reporting a clinical case, a male patient who suffered facial trauma after interpersonal violence with a sharp pointed object. Initial wound management is performed on a delayed basis and at 3 weeks later, direct wound closure is performed in the chin and parotid region, in addition to a locally rotated flap in the left buccal region. In our experience, the use of local rotational flaps is an advantage for closure in traumatic facial wounds, being an alternative of choice due to its versatility in design, providing functional results with aesthetic outcomes.Keywords: Facial Injuries; Facial Trauma; Rotation Flap; Reconstructive Surgery; Case Report
154 Recovery from Auditory Neuropathy Spectrum Disorder Post-Traumatic Brain Injury: A Case Study , Suman S Penwal and Chandrahas U Chandanshive
Background: Auditory neuropathy spectrum disorder is a retrocochlear pathology. It is marked by an abnormal transmission of stimuli by the auditory nerve. The purpose of the study is to illustrate the audiological profile of the infant with post-traumatic brain injury and subsequent recovery observed in follow-ups.Methods: In the present case study report a 3-month-old infant was undertaken for detailed audiological evaluations and follow-up. The infant was suffering from right-sided paresis post head injury. The case underwent the diagnostic audiological test battery using standard norms and protocols. All the test procedures were non-invasive and complied with the declaration of Helsinki.Results: The audiological test array suggested the presence of auditory neuropathy spectrum disorder in the left ear. However, the absence of contralateral reflexes in the opposite/ better ear was suggestive of bilateral retrocochlear pathology. The repeat evalua-tion revealed recovery from the retrocochlear pathology.Conclusion: The recovery was attributed to the activity-dependent neuroplasticity and spontaneous drainage of neurotoxic blood accumulation in the brain.
155 Subcutaneous Venolymphatic Malformation in the Neck: A Unique Presentation , Vishnu Varathan Moganadass, Shashi Gopalan and Kasturi N
Venous malformation is one of the most common type of congenital vascular malformation which normally involves the lymphatic system. It is a common type of congenital vascular lesion with recorded incidence of 0.01%, from this 0.01%, 40% is from the neck region, 40% occurs in the trunk, and another 20% in the extremities. The pathogenesis remains unclear. This article elaborates on the type of venous malformation, imaging modality assisting to come to a definitive diagnosis. Surgical excision is the best compared to non-operative method in managing superficial well encapsulated localized venolymphatic malformation
156 New Born Hearing Screening-An Essential Tool in Early Identification of Deafness in Children , Bhavya BM, Trupti U Bhat and Neeraj Suri
Background:Hearing impairment is one of the most critical sensory impairments. Universal Newborn Hearing Screening (UNHS) is a standard practice in most developed countries. However, in developing countries like INDIA many obstacles like unawareness, inaccessibility, lack of infrastructure reduce the sustainable rate of screening for early identification. This study aims to review the benefits and results of universal newborn hearing screening, to propose a standard protocol for screening of all newborns irrespec-tive of high-risk infants, hospital/home deliveries.Materials and Methods: This cross-sectional study conducted by Department of ENT, GMERS Medical College, Gandhinagar, Gujarat along with TARA foundation screened 31460 neonates, infants and children, between 2017 - 2018. All infants were initially screened with OAE, and those who failed were subjected to ABR/BERA. Results: All children were screened with OAE as 1st stage screening procedure, out of which 4557 (14.48%) showed positive results. At 2nd stage OAE refer children were subjected to ABR, in which 1322 (29.01%) children were found having deafness which was confirmed by audiologist and otorhinolaryngologist. Out of the 1322 diagnosed with deafness, 746 (56.42%) patients had history of NICU admission, 268 (20.27%) patients had history of consanguineous marriage, while 308 (23.31%) patients had no risk fac-tors. Thus highlighting the risk factors in congenital deafness detection, and the need for universal screening over selective high risk screening.Discussion: Current recommendations are to screen all infants for hearing loss early in life for timely intervention. A two-step screening with OAE and ABR has to be implemented which can reduce the no of missing cases due to lost follow up. A new initiative ‘DHWANI on wheels’ has been implemented with OAE and ABR carried out by trained audiologists in a mobile van, to tackle the issue of inaccessibility and unawareness in remote areas. Conclusion: As normal hearing is critical for speech and language development, UNHS is a strategy that enables to identify congeni-tal hearing loss early and provide appropriate intervention as early as possible for optimal benefits.Keywords: UNHS; OAE; ABR; Neonatal Hearing Screening; Congenital Hearing Loss
157 3D Scanner Applied to Patients Under 18 Years of Age: Has the Time Come to Rewrite the Regulations for Use? , Barbero A, Morales M and Roldán L
The arrival of 3D digital scanning systems for patients' ears has revolutionized one of the most classic fields of Audiology, that is, the manufacture of custom silicone molds for the patient's ear. This is an efficient and clean system due to the accuracy it provides. But while performing 3D ear scanning for children, we face a big obstacle. That obstacle is that the instruction manuals of the manu-facturers of the 3D Scanner indicate that it is used only for those over 18 years of age. In other words, we must give up one of the most important fields of our profession which is Pediatric Audiology.This aspect is treated in this opinion article from the perspective of the authors' own experience and reflects their personal contribution in this field throughout their 30 years of work and experience, making classic silicone molds and the new 3D molds by scanning. Our opinion article is intended to suggest a change in the current use of 3D scanning with children.The exact copy of the ear is a tremendously important aspect while examining patients with severe and/or profound deafness, especially at an early age. But there are some teenagers of 12, 14 or 16 years old, who have a wide enough conduit to be able to use the Otoscan 3D, especially if they have been using tight molds since they were little. And there are also adult patients with a very small ear canal, which makes scanning impossible.For this reason, our proposal and recommendation is to change the instruction manuals for use from 2021 so that the limitation is not based on age, but on the diameter of the ear canal. In this way, the responsibility of the manufacturers of the equipment is safeguarded (which is one of their main concerns and basis of the reason, in the event of possible legal claims), and allows flexibility in use based on a technical/audiological criterion, instead to be based on a mere question of ages
158 Tuberculosis in Otorhinolaryngology Uncommon but Not Rare , Casas Ocando Julio
Tuberculosis is one of the principal causes of disease and mortality in the world, occurs in children and adults, as an acute, sub-acute, or chronic infectious disease which affects all tissues of the body and represents approximately 80% of tuberculosis cases in adults. Of the forms of extrapulmonary tuberculosis, the most frequent location is lymphatic and is rarer in the ENT area but is still an important form of extrapulmonary tuberculosis, which makes it an important clinical and diagnostic challenge to the otolaryngolo-gist. The diagnosis of disease must be demonstrated by the culture of Mycobacterium tuberculosis or by histology.Keywords: Tuberculosis (TB); Mycobacterium tuberculosis; Otorhinolaryngology
159 Intracranial Tuberculoma , Ramakrishna Bethanabatla and Ahmad Taha
Mycobacterium tuberculosis (MTB) intracranial tuberculomas are rare and account for approximately 1% of all cases. Central nervous system (CNS) involvement is a serious condition if not treated adequately. We present a case of a lady who presented with Headaches.Keywords: Mycobacterium tuberculosis (MTB); Central Nervous System (CNS);Intracranial Tuberculoma
160 Case Report: Submandibular Metastasis in a Case of Buccal Malignancy: Role of Ultrasound , Rajesh C Kamble, Alpana N Joshi and Pravin Mestry
Head and neck cancer is the 6th most common malignancy worldwide, and oral cavity tumors account for nearly one-third of the tumors. It’s become usual trend to subject head and neck cancer patients for CT scan/MRI neck to diagnose these primary lesions and evaluate its loco regional as well as distant spread.This case report strongly emphasizes the role of high frequency linear transducer and intra oral ultrasound imaging for diagnosis of oral cavity tumors.Cervical lymph node metastasis plays an essential role in the treatment and prognosis of head and neck cancer patients. The assessment of the cervical lymph node status still remains an unsolved problem and ultrasound can be a great tool to detect these lymph nodes, characterize them and also in follow up of all post-operative patients.Real time USG guided FNAC/tru cut biopsy of these lesions can help in primary diagnosis of these neoplastic lesions.Keywords: Submandibular Metastasis; Buccal Malignancy; Intra Oral and High Frequency Ultrasound
161 Rare Case of Benign Spindle Cell Lesion in Subglottis , K Krishna Kumar and VJ Niranjana Bharathi
An upper airway obstruction secondary to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report a 16 year old girl who was misdiagnosed as bronchial asthma whereas finally diagnosed as spindle cell lesion of subglottis. The challenging feature of head and neck pathology is a varied array of spindle cell lesions ranging from reactive to malignant and very aggressive. Hence an accurate diagnosis is critical which can be obtained with the help of diagnostic and radiological facilities.Keywords: Subglottic Mass; Spindle Cell Lesion
162 Mucormycosis - The Dark Shadow of Coronavirus , Arya Ajith
As the crippling crisis of Covid-19 infection continuous to dev-astate India new deadly complications of the infection have sur-faced. The Coronavirus’s new partner in crime is the deadly fungal infection mucormycosis or as the media has named it “Black Fun-gus”.Mucormycosis is a rare but deadly opportunistic fungal infec-tion, commonly seen in immunocompromised patients. It belongs to saprophytic fungi group - Mucorales order and Zygomycetes class. The mode of infection is usually via the inhalation route and infection begins in the nose and paranasal sinuses with vascular invasion, forming thrombi in the blood vessels, leading to reduced blood supply and tissue necrosis of nearby tissue and osteomyeli-tis. It is an aggressive and potentially fatal infection more common-ly observed in immunocompromised patients.
163 Impact of the Covid 19 Pandemic on the Wellbeing of Children , Radha Balaji
Starting from December 2019 the COVID-19 disease caused due to SARS-CoV 2 virus spread its wings all over the globe by Feb-ruary 2020 and was declared a Pandemic in February 2020 by WHO. With no immediate treatment available countries resorted to adopting stringent preventive measures such as social distancing, wearing of face masks and frequent hand washing. As these mea-sures did not yield the desired results, authorities to breakdown the chain of the virus transmission, enforced lockdown measures of varying degrees resulting in the closure of schools and educational institutions, and denial of access to public places such as gardens, malls, theatres and religious places where large assemblages are unavoidable. While house quarantine affected all, the impact of confinement in homes has had a serious adverse effect on the physical and mental health of growing children. School closures have led to lack of outdoor activity, aberrant dietary and sleeping habits, physical inactivity sedentary behaviour and anxiety with poor cognition. Studies conducted across many countries have sought to analyse the impact of the pandemic from different perspectives. Most of the studies were on the children as a whole without taking into consideration their socioeconomic conditions. However, in this paper, we analyse the impact of the Pandemic on children of different strata in India. The effects of home quarantine were studied by dividing the children into two socioeconomic groups - children from well-to-do households and children from underprivileged families. The studies of a few (20 in number) children were found to be on the lines of investigations of children elsewhere. Keeping in mind Indian conditions particularly concerning underprivileged children certain recommendations are made over and above the guidelines of WHO. Implemented by parents, caretakers and elders at home we may minimize the ill effects of home quarantine dur-ing the lockdown periods.Keywords: Covid-19; Physical Activity; Mental Health; Underprivileged Children
164 Clinicopathology Study of Middle and External Ear Lesions: A Ten-Year Retrospective Study, Yazd, Iran , Hamed Ghoshouni, Shokouh Taghipour Zahir, Parastou Mahdaviyeh, Koorosh Rahmani and Mohammad Shafiee
Introduction: External and middle ear diseases and tumors are among the most common cases referred to the ear clinic. These lesions can range from benign inflammatory lesions to metastatic tumors. Therefore, in this study, we aimed to study middle and external ear biopsy lesions to obtain information about the frequency distribution of gender, age and their clinical symptoms so that we may be able to take steps to detect them early and prevent their spread.Methods: This descriptive and cross-sectional study was performed retrospectively. The data were collected through a premade questionnaire, including demographic data such as age, gender, the precise anatomical location, the involved side, clinical symptoms, and pathology report. Then, the obtained data were statistically analyzed through SPSS software version 17.Results: Total 542 patients were enrolled in this study, whom 332(61.3%) of them were male and 208 (38.3%) of them were female. The mean age of patients was 36.93 18.51 years old. Between them 57 (10.5%) of cases were malignant, and 485 (89.5%) were benign. There was a significant relationship between the pathologic types of middle and external ear lesions with age, gender, and clinical symptoms (PV < 0.001). Most lesions were seen in men older than 50 years. The benign lesions such as cholesteatoma were the most widespread lesion in the middle ear, mostly observed on the left side. The majority of patients with cholesteatoma were between 20 and 39 years old.Conclusion: The results of this study showed that there is a close relationship between clinical symptoms and the type of the lesion. Most benign lesions presented with otorrhea and hearing loss, while most malignant lesions were presented as ulcerated lesions.Keywords: External Ear; Middle Ear; Pathology; Lesion
165 Early Identification of Hearing Loss in New-Borns - A Challenging Process , Saravana Jayabalan
Acta Scientific Otolaryngology Volume 3 Issue 6 June 2021Early Identification of Hearing Loss in New-Borns - A Challenging ProcessSaravana Jayabalan*ENT Specialty Clinic, Al Kuwait Hospital, Dubai City, United Arab Emirates*Corresponding Author: Saravana Jayabalan, ENT Specialty Clinic, Al Kuwait Hospital, Dubai City, United Arab Emirates.NewsletterReceived: May 18, 2021Published: May 28, 2021© All rights are reserved by Saravana Jayabalan.Neonatal hearing screening also known as early hearing de-tection and intervention programs in several countries refer to those services aimed at the early identification, intervention and follow up of infants who are all vulnerable with hard of hearing. It’s important to know what to expect as our babies grow, because hearing problems can delay the development of speech and lan-guage skills. In 1970, the American speech and hearing association, American Academy of Ophthalmology and Otolaryngology, Ameri-can Academy of Paediatrics to form a national Joint committee on infant hearing (JCIH)
166 Is there Risk of Hypercapnia from Prolonged Use of N95 Filtering Facepiece Respirators? , Nicolás Solano, Arianny Peraza and Enmanuel Parra
Due the pandemic outbreak associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the use of PPE is of vital importance allowing the prevention and control that can limit the spread of the disease. According to the FDA, an N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne par-ticles, where its edges are designed to form a seal around the nose and mouth. Maxillofacial surgeons, as well as others who perform procedures in the head and neck region, are at high risk of being exposed to and infected by COVID-19 [1]. Lately, there has been concerns about the risk of the prolonged use of N95 filtering face piece respirators (FFR) as a part of personal protective equipment (PPE) on the healthcare workers, however, research associated with the potential long-term physiological impacts on the use of N95 FFRs has been limited.
167 Mucormycosis in Context of the COVID-19 Pandemic , Puja Chatterjee
While the coronavirus 19 pandemic continues to be a world-wide healthcare crisis, we might be heading towards an era of post covid complications of near pandemic proportions.Rhino-orbital Mucormycosis is a well-known deadly, acute and aggressive infection affecting patients in Otolaryngology practice. This disease particularly affects immunocompromised patients and those with diabetes mellitus. It is caused by inhalation of spores of fungi in the order Mucorales, most commonly from the genera Rhizopus, Mucor and Rhizomucorwhich are ubiquitous in nature in soil, growing rapidly with spores that can become air-borne. The enzyme Ketone reductase enables these organisms to thrive in glucose rich, acidic environments. Two out of three cases of Mucormycosis are sinonasal
168 Mucormycosis Infection in COVID-19 Patients in India: An Emerging Lethal Threat , Nazia Begam and Abu Bashar
Opportunistic fungal infections have been reported to be asso-ciated with COVID-19 disease. Mucormycosis, an invasive fungal disease is being increasing being reported from India in patients with COVID-19 infection with comorbidities like diabetes. The in-creasing number of mucormycosis cases among Covid-19 patients during the current second wave of the pandemic is alarming own-ing to lethal sequels of the disease
169 Childhood Obstructed Sleep Apnoea and the Role of the ENT Surgeon , Nalini Bhat
Obstructed Sleep apnoea (OSA) is characterized by oxygen de-saturation and reduced upper airway airflow despite preserved thoracic and abdominal effort. It occurs due to periodic partial col-lapse of the upper airway during sleep. It is typically associated with the elderly, especially males. The incidence of childhood OSA is much less (1 - 4%) [1] as compared to adults (20%)[2]. Yet the effect of prolonged poor sleep and inadequate oxygenation can have several deleterious effects on the child’s health. OSA has been reported to cause poor feeding and failure to thrive, developmen-tal delay, hyperactivity, learning difficulties, personality changes and depression in children. It has also been reported to result in hypertension and cardiac issues in the long term
170 Modified Labiomandibuloglossotomy Approach for Solid Tumor of the Floor of the Mouth: A Case Report and Literature Review , Nicolás Solano, Bairon Castro, Ejusmar Rivera and Anixa Álvarez
Surgical access for tumors found on the floor of the mouth represents a challenge for surgeons due to its location. Different tech-niques have been described for this type of tumors (transcervical, transmandibular, transparotid, transoral), however, sometimes they have anatomical limitations. The purpose of this study is to describe a modified labiomandibuloglossotomy approach through a case report of a 36-year-old male diagnosed with adenoid cystic carcinoma on the floor of the mouth. Performing this technique allows more exposure for the resection of these tumors, without damaging the adjacent anatomical structures. Previous planning and respect for facial aesthetic subunits as references for surgical incisions optimize the aesthetic results and wound healing when performed appropriately. The proper selection of the patient, exposure, modification of the surgical technique and its complications will be discussed.
171 Rhino-Orbital-Cerebral Mucormycosis: Battle for Life Continues, Post-COVID , Manish Gupta
Mucormycosis is an invasive fungal infection of nose and pa-ranasal sinuses by fungi from family Mucoracea, is usually seen in diabetic and immunocompromised patients. In patients with COVID-19, the early start of high dose steroids even in mild stage, the use of immunomodulators (Tocilizumab), longstanding oxygen therapy and previous uncontrolled diabetes mellitus are the im-portant factors predisposing to this fulminant infection.
172 Tobacco Usage and Assessment of Oral Health and Knowledge of Oral Cancer Amongst OPD Patients in a Tertiary Hospital in Sikkim , Upasana Kotoki, Mohonish N Chettri
Tobacco is one of the major health problems in Sikkim as it is worldwide. Oral cancer is common in Asia, and this is due to its association with smoking betel and alcohol consumption. Incidence varies, with highest rates in South Asia, particularly India, Ban-gladesh, Sri Lanka, Pakistan and Afghanistan. This is a cross sectional study on 100 patients attending OPD in a tertiary care hospital. The data for the Tobacco usage was assessed using a questionnaire which is adapted from a published article of similar nature in a different setup and location and the dependence of Nicotine was assessed using Fagerstrom questionnaire. This small scale hospital based study is an attempt to see the trends of Tobacco consumption in patients presenting to tertiary care hospital in Sikkim with the GATS Indicators of India 2016-2017. The consumption trend are in line whereas the knowledge attitude and perception seems to be better. The alleged data on exposure of second hand smoke in public places restaurants etc. seems to be more than the national average so does the motivation to quit based on various initiative seems to be on a higher front.Keywords: Tobacco; Smoking; Nicotine; Fagerstrom; Oral Cancer
173 Anterior Nasal Chondroma: A Common Chondroma in an Uncommon Location , Moshe Baitelman, Kelcy McIntyre, Paul Young
Background: Of the rarely reported chondromas of the nasal septum, most arise from the posterior septum. This article presents a rare case of a chondroma arising from the columellar space, anterior inferior to the septum. Case Report: A 62-year-old female presented with a one-year history of post-nasal drip and 3 months of nasal congestion. Physical exam revealed a firm, well-circumscribed mass in the columella of the nose. Computed tomography (CT) and histopathology was performed. Endoscopic excision of the mass was performed.Results: Computed tomography (CT) image readings described a 2.1 x 1.5 x 3.0 cm, relatively smooth mass from the anterior-inferior nasal septum with homogenous density and no internal calcification. Histopathology revealed a benign chondroma. Post-operatively, she reported significant improvement of symptoms. No recurrence as of 9 months follow-up.Conclusion: We present a rare case of anterior inferior nasal benign chondroma. Chondromas should remain on the differential when investigating nasal masses. Keywords: Chondroma; Nasal Chondroma
174 Objective and Subjective Evaluation of Nasal Patency Post Septal Surgery: A Single Center Case Series , Jalal Al Marzooq, Fatema Alasfoor
Introduction: Nasal obstruction due to a deviated nasal septum is a common indication for nasal septal surgery. Thus, septoplasty is one of the most common procedures in otolaryngology practice. This is a clinical prospective case series study that subjectively and objectively assessed the impact of septoplasty and septorhinoplasty on nasal obstruction.Materials and Methods: Patients undergoing septoplasty or functional septorhinoplasty after no clinical improvement of nasal obstruction with medical treatment were assessed by measuring the Peak Nasal Inspiratory Flow and using Sino-nasal Outcome Test-22 questionnaire before and three months after surgery. Results: Twenty-five patients were included in the study. Pre- and post-operative measures showed statistically significant differ-ence in the Peak Nasal Inspiratory Flow measurements with a mean increase of 38 (99% CI24-52, SD 24, p < 0.001) and in the Sino-nasal Outcome Test-22 questionnaire scores before and after surgery with a mean decrease of 26 (99% CI 32-19, SD 12, p < 0.001).Conclusion: This study suggests that septoplasty and septorhinoplasty improve nasal breathing as well as related disease specific quality of life. Keywords: Nasal Obstruction; Deviated Nasal Septum; Septoplasty; Septorhinoplasty; PNIF; SNOT-22
175 Case Report on Adenoid Cystic Carcinoma of Larynx: A Rare Tumour , N Vishnu Swaroop Reddy, Prathiba Reddy T
Adenoid cystic carcinoma (ACC) of larynx is a rare malignant tumour with unknown aetiology. It accounts for less than 1% of all laryngeal malignancies worldwide. ACC of larynx is slowly progressive and arises from accessory salivary glands. It is known for mul-tiple recurrences and distant metastasis, which may occur even 5 years after treatment. In this article we report a case of 57 year old women with laryngeal adenoid cystic carcinoma who presented with a 5-month history of hoarseness of voice and noisy breathing. The patient underwent elective tracheostomy and biopsy followed by total laryngectomy with bilateral neck dissection. As laryngeal adenoid cystic carcinomas are well known for relapses and metastasis, regular follow up is necessary for early detection
176 Swallowing Management in Self-Inflicted Cutthroat Injury and Longstanding Substance Abuse: A Case Study , Suman S Penwal, Bhumi A Gaikwad and Jyoti S Mohite
Background: Suicide is the leading cause of death. Self-inflicted cutthroat injury although rare but is one of the ways for attempting suicide. The cutthroat injury lacerates the major blood artery, soft tissue, cartilage and nerve supply in the neck region. Additionally, substance abuse is found to reduce psychological and cognitive flexibility that induces suicidal tendencies.Methods: The current case study presents the holistic management of voice and swallowing difficulties faced by a 25-year-old man with a cutthroat injury and a history of substance abuse.Results: The client could manage foods of all consistencies without any difficulty. He also had shown improvement in voice quality, post-therapy. Conclusion: The article highlights the recovery of impaired swallowing and voice function in the case of dual trauma caused by cut-throat injury and substance abuse.
177 td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;} Craniofacial Dysostosis Associated to Sars-Cov-2. A Case Report , Nicolás Solano Parra, Valentina Gutiérrez, Paulina Gutiérrez and Ana Villarroel
Craniofacial dysostosis refers to the syndromic forms of craniosynostosis, characterized by a sutural abnormality with cranial vault involvement that extends to the skull base and the middle third of face structures. Clinical manifestations reports of SARS-CoV-2 in pregnant women are limited, therefore this manuscript objective is to report a clini-cal case of a newborn with craniofacial dysostosis associated with SARS-CoV-2 infection during pregnancy.
178 Translation of the Tonsil and Adenoid Health Status Instrument to the Arabic language , Ghassan Haddad and Randa Al Barazi
Background: Adenotonsillectomy is one of the most commonly performed pediatric surgeries worldwide. To date, no questionnaire assessing the quality of life of patients post-operatively exists in the Arabic language. Our objective is to translate the Tonsil and Ad-enoid Health Status Instrument from English to Arabic and evaluate its internal consistency. We then attempt to use the translated questionnaire to assess the change in quality of life of patients undergoing adenotonsillectomy.Methods: Translation of the English TAHSI was performed using the guidelines for cross- cultural translation of quality of life mea-sures. The obtained version of the questionnaire in Arabic was used on 141 patients enrolled prospectively over 3 years to assess for validity and internal consistency. Patients were enrolled from the pediatric otolaryngology clinic at the American University of Beirut Medical Center.Results: Cronbach alpha coefficients for the pre-operative and post-operative translated questionnaires were 0.79 and 0.78 respec-tively, confirming adequate internal consistency. Mean total pre-operative score was 28.88 ± 10.80, significantly higher than the mean post-operative score of 5.00 ± 5.57 (p < 0.0001) showing an improvement in quality of life after surgery.Conclusion: In this study we successfully translated the Tonsil and Adenoid Health Status Instrument from English to Arabic. The questionnaire obtained is the only available quality of life measurement tool in Arabic specific to adenotonsillectomy. It was used to show that adenotonsillectomy significantly improves the quality of life of patients.
179 Covid 19 Associated Mucormycosis: An Epidemic , Kanishk Mehta, Priti Agarwal and Swati Jain
Patients with Coronavirus disease (COVID-19) are commonly treated with broad spectrum antibiotics, glucocorticoids and/or immune modulators. This has led to development/exacerbation of opportunistic fungal infections. Mucormycosis is one such disease that complicates the course of severe COVID-19. Here we present a study of 15 patients and their epidemiology who were diagnosed with Covid19 Associated Mucormycosis (CAM) at our institute - the highest number of cases in literature. Keywords: Mucormycosis; COVID19; Immunosuppression
180 The Use of COSI Questionnaire to Evaluate the Effect of Input Dynamic Range Variables on Cochlear Implant Performance in Postlingual CI Adults , Tarek Abd El-Aziz Ghannoum, Mona Hassan Selim, Amira Maged El-Shennawy and Zahraa Mohamed Yousry Elbohy
Background: If our goal is to obtain optimal patient performance in everyday life; clinical fitting should improve the cochlear implant (CI) users’ ability to understand soft speech as well as speech in noise. It is of great value to change the input dynamic range (IDR) characteristics for CI performance optimization in daily life. Aim of work is to use the Client Oriented Scale Improvement (COSI) qu-estionnaire for evaluation of the effect of different IDR characteristics on CI performance.Methods: The study group is comprised of fourteen postlingual CI adults who were implanted and used their devices for at least 6 months. Programs were adjusted for four input sensitivity settings differing in threshold (T) and comfortable (C) levels, microphone sensitivity (MS) and volume sensitivity. Subjects were assessed subjectively by using COSI questionnaire 2 weeks after each program setting.Results: The commonest specific needs in the patient population were firstly to hear conversation with group in noise. Both 3rd and 4th programs revealed the highest percentage of hearing final ability at both 2nd and 3rd important listening situations. This means that patients preferred the programs with the maximum microphone sensitivity, and C level set below MCL.Conclusion: COSI questionnaire highlights the specific needs of the CI user referring to the advantages of the CI in those situations. High microphone sensitivity settings might make low-level sounds more audible. C level might need to be reduced to an acceptable level. Based on our results, high microphone sensitivity and setting of C level below MCL should be taken into consideration.
181 How Can an Attention-Grabbing and Thought-Provoking Case Keep the Mind Ticking for a Challenging and Perplexing Diagnosis??? , Sphoorthi Basavannaiah
When a patient complaints with various symptomatology, a “syndrome” like picture often runs through the mind. Here, is one such female patient who presented with an unusual and interesting case with multiple cranial nerve involvement in the areas of ear, nose and throat with its symptomatology ranging from tinnitus to trismus along with facial numbness to paranasal sinus tenderness. When all these symptoms amalgamate, the mind wanders and raises queries to plenty of differentials. Hence, approach to one such diagnosis is demanding. Keywords: Syndrome; Cranial Nerve Palsy; Extrapulmonary Koch’s; Cervical Lymphadenopathy
182 Endoscope Assisted Cosmetic Excision of Forehead Lipoma , Zeeshan Arif and Kritika Rai
Lipoma is one of the most common benign soft tissue tumors of the forehead. Multiple techniques have been described for exci-sion of tumor of the forehead. Endoscopic techniques have gained popularity in head and neck surgery. In the excision of forehead lipomas, minimally invasive endoscopic excision allows inconspicuous incision placement, better visualization of operative field, fewer complications and faster return to work. We present a case of endoscopic excision of a forehead lipoma using a single incision approach. The procedure provided a better cosmetic result as there was no visible scar, leading to greater patient satisfaction. There were no post operative complications. In conclusion, endoscopic excision is a safe and effective method for excision of forehead lipo-mas. It provides a better cosmetic result and faster return to work, thereby leading to greater patient satisfaction.
183 Angiosarcoma in the Maxillary Sinus. How Frequent is it? A Case Report and Literature Review , Nicolás Solano, Ligia Pérez, Ana Villarroel and Betsabe Sarcos
Angiosarcoma is a rare of malignant and aggressive neoplasm characterized by the vascular endothelium growth that frequently oc-cur in the elderly population. This entity can be presented in the head and neck region, especially in the superficial soft tissue of the scalp and face being the paranasal sinus an uncommon primary location for angiosarcomas accounting for less than 0.1% of all para-nasal sinus malignancies. Epistaxis, nasal obstruction and nasal discharge are characteristic symptoms when this type of neoplasm is located in the paranasal sinuses. In this paper, we present a rare case of angiosarcoma in the maxillary sinus with an oral clinical manifestation as well as make a literature review of this unusual entity.
184 Cervical Mass. Experience and Management Protocol , Solano Nicolás, Villarroel-Dorrego Mariana, Parra Enmanuel, Rivera Ejusmar, Dueñes Greyner and Atencio Maria
Thorough history and physical examination combined with a fundamental knowledge of head and neck anatomy can arm the primary care provider with all tools necessary to work up and properly diagnose a neck mass. Not all neck masses are neoplasms; the location of the mass, details surrounding its appearance, and overall time course are important factors to help differentiate neo-plastic disease from other possibilities in the long differential diagnosis. In-depth knowledge on the part of the health professional about the management of a cervical mass is crucial, especially those professionals whose field of action involves the head and neck area (oral and maxillofacial surgeons for example) at that, the objective of this investigation is to provide a review of the literature and relate our experience and management protocol for cervical masses in the Oral and Maxillofacial Surgery Unit of the Hospital Coromoto, Venezuela.Keywords: Cervical Mass; Management Protocol
185 Tinnitus Origin: A Brief Review of Theories , Sirvan Najafi, Kamran Ghaderi, Negar Azizi and Abdosalam Mirani
Tinnitus is the feeling of sound in the ear(s) or head, without external physical origin [1]. The otologic and non-otologic factors may contribute to tinnitus; however, the cause of tinnitus is un-known in approximately 30% of cases [2,3]. The most common type of tinnitus is subjective tinnitus, in which the sound can be perceived merely by the patient [2]. The tinnitus prevalence of in different studies varies according to reasons such as the exact defi-nition of tinnitus, data collection method, etc
186 Empty Nose Syndrome , Junaid Shahzad
First of all I would like to thanks AS Otolaryngology Journal, for giving me an opportunity for writing this editorial note. Being an ENT specialist, I have encountered a few cases of Empty nose syndrome. I found it demanding to manage with psy-chological issues associated with it. Underneath is the brief review about this challenging issue.
187 Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body , Nikolay P Serdev
Scarless closed approach suture liftings present skeletal fixation with skin punctures without incisions as a first alternative to classic excision lifts. We started the anatomy study, instrument creation and thread selection in 1990 and the whole topographic anatomy, instrumentarium and technique understanding of this new method was ready in 1993 [1-4]. Needle preparation and selec-tion of threads was experimental. For threads we have performed stretch, elasticity and cut through tests. Thread long term absorp-tion is crucial in our method. In the year 1993 - 1994 [2] we have operated54 patients to correct early ptosis and flabbiness in areas of face and body and published our results. Our contribution is that our closed approach suture techniques lift SMAS and fascias without traditional incisions. Operations are ambulatory with excellent results, reported by the patients. The trauma is minimal and the follow-up period is no longer than hours to 3 days with fast, sometimes immediate return to work and social life. There are no visible scars, the needle perforations on the skin are not visible after days
188 Surviving Mucormycosis: Impact on Psychological Well-Being and Quality of Life , Ankesh Singh and Ayushi Gupta
Mucormycosis is a rare but serious fungal infection commonly affects the sinuses/lungs after inhalation of fungal spores from the air, usually affecting people with a compromised immune system. In the wake of COVID-19 pandemic, a multi-fold rise was seen in cases of mucormycosis or “black fungus” which was earlier a rare entity. This has added a great burden on the patients and their caregivers physically, financially, emotionally as well as psychologically. The high morbidity and mortality rates of mucormycosis can cause psychological impairment and decreased quality of life. Along with the patients and their caregivers, the treating doctors are also in duress as informing the family members about the poor prognosis of such an acute disease takes a toll every day. Most patients require a combined approach of surgical debridement and Liposomal Amphotericin B. The unavailability of Amphotericin B has led to suboptimal dosages in many patients in India. Loss a sense organ(s) like eye in cases of orbital involvement or any other part of the body like maxilla or palate, can lead to dependence on others for care and one’s own perception of themselves as a member of the society. Psychiatric manifestations can be a direct accompaniment in the aftermath of surgical debridement/ resection procedure for Mucormycosis. Addressing psychological functioning sequelae related with Mucormycosis, especially after surgical treatment for the disease; along with rehabilitation and psychotherapeutic sessions should be encouraged as a part of treatment in patients of Mucormycosis such that they continue to be functioning members of the society. Keywords: Mucormycosis; Black Fungus; COVID-19; Psychological Impairment; Rehabilitation
189 The Headache Tale: An Unknown Link between the Head and Neck Muscles, Jaws and the Teeth , Anmol Agarwal
Majority of individuals suffer from headache due to varied reasons, either known or unknown. Based on the aetiology, over 200 types of headaches have been reported in the literature al- though ‘myogenous headache’ or the headache originating from the muscles, remained unlearnt and unexplored. Physiologically, head and neck muscles, jaws and the teeth function in harmony and contribute in vital functions like mastication, posture preser- vation, airway maintenance etc..
190 Managing Odontogenic Keratocysts: An Enygma? Considerations to Choose the Correct Approach , Lopez Jondalys, Solano Nicolás, Rivera Ejusmar, Castrillo Ariamay and Chirinos Yenielis
Purpose: The aim of this study is to propose a protocol for the appropriate management and treatment of odontogenic keratocysts. Materials and Methods: A longitudinal descriptive study on patients with odontogenic keratocysts surgically treated in the Oral and Maxillofacial Surgery Unit of the University Hospital of Maracaibo, Venezuela during the period between January 2015 and January 2020. Using a management algorithm, the treatment modality for each patient was described based on clinical, radiographic charac- teristics and biological behavior of the lesion. Results: 10 patients were included in the study. The average age was 44.7 ± 21 years and 60% of the patients were female. All lesions were located in the mandible, 2 of the lesions had radiographic evidence of cortical perforation. The average radiographic diameter of the lesions was 6.3 ± 2.2 cm. Regarding the surgical variables, 7 patients received decompression + residual cystectomy, 1 patient enucleation and curettage and 2 patients received marginal or en-bloc resection. Conclusion: It is necessary to unify different variables, like biological behavior and surgical and radiographic characteristics, since they are widely scattered in the literature and thus being able to protocolize the management of these lesions to obtain better results and decrease the recurrence rate. Keywords: Odontogenic Keratocyst; Decompression; Enucleation; Resection; Recurrence
191 Transoral and Extraoral Approaches for Benign Tumors of the Jaws. Which One to Use and When? , Nicolás Solano, Paulina Gutiérrez, Jaime Jiménez, Ana Villarroel, Ejusmar Rivera and Luis Herrera
Purpose: To create an algorithm for the selection of the ideal approach for benign tumors of the jaws based on the authors’ experi- ence and a literature review. Patients and Methods: A retrospective study was performed, including patients treated for the surgical resection of benign tumors of the jaws at the Oral and Maxillofacial Surgery Unit of the University Hospital of Maracaibo, Venezuela between January 2016 and March 2020. Approach selection criteria were divided into major and minor. Results: A total of 28 patients were included in the study, from the studied tumors, ameloblastoma (53.57%) and ossifying fibroma (21.42%), were the most common pathologies; 21 cases were treated using a transoral approach (75%) and 7 cases were treated with an extraoral approach (25%). There were complications in 5 cases (17.85%), from these complications, 4 of them occurred in patients treated with a transoral approach (14.28%) and 1 occurred in patients treated with extraoral approaches (3.57%). Conclusion: Selection of a proper approach for benign tumors of the jaws is very scarce, many factors should be taken into account in order to choose the proper approach that allows the total elimination of the lesion as well as the subsequent reconstruction of the defect, minimizing the aesthetic and functional consequences. Keywords: Approach; Tumors; Jaws; Transoral; Extraoral
192 Secondary Repair of Unilateral Cleft Lip Nasal Deformity with Guide Sutures , Haidong Li and Shikang Gao
The objective of this study is to explore the method and curative effect of secondary repairing nasal deformity of unilateral cleft lip by using guide suture. In an attempt to do so, 5 cases were put under research. The 5 cases of unilateral cleft lip with nasal deformity were repaired by using a certain method to reduce surgical intervention in the pterygoid cartilage by suspending the suture with a Guiding device after the lateral crus of the greater alar cartilage is fully detached from the margin of the piriform aperture. The cases were followed up for 6 - 12 months, as the results revealed that all the incisions healed in the first stage after the operation. In ad- dition to that, both the bilateral alar cartilage and nostril of 5 patients were symmetrical. Furthermore, the sum of absolute values of bilateral nasal aperture differences was less than 3 mm, as the appearance of all angles was satisfactory. The rhinoplasty incision was limited to ill side nostril margin and inside ill side the nostril. The patient’s healthy side nostril and columella showed no scar incision. To sum up, the secondary repair of unilateral cleft lip nose deformity by using the Guiding device with a minimally invasive suspension suture of greater pterygoid cartilage after the lateral crus of the greater alar cartilage is fully detached from the margin of the piriform aperture is a good method for anatomic reduction of alar skin, cartilage and mucosa on the side of cleft lip with good clinical effect. Level of Evidence: IV. Keywords: Cleft Lip; Nasal Deformity; Repair Surgery; Surgical Flap; Rhinoplasty
193 Atypical Lobular Capillary Hemangioma as an Unusual Presentation in Mandible: Case Report and Literature Review , Nicolás Solano, Ligia Pérez, Valentina Gutiérrez, Paulina Gutiérrez, Betsabe Sarcos, Ana Villarroel and Ariamay Castrillo
Lobular capillary hemangioma (LCH), commonly described in the literature as "Pyogenic granuloma" is a reactive tumor-like lesion commonly affecting the oral cavity closely related to trauma, chronic irritation and hormonal changes. Clinically, the lesion ap- pears as a smooth, lobulated, exophytic mass, exhibiting pink to reddish-purple in color and usually easy bleeding. The size of lesion varies from millimeters to centimeters, rarely exceeding 2 - 2.5 cm. We report a clinical case of lobular capillary hemangioma of the mandible in a male patient with unusual clinical presentation and imaging features. Keywords: Oral Pyogenic Granulomas; Lobular Capillary Hemangioma; Reactive Lesion; Vascular Lesion
194 An Update of Bronchoscopy in Pediatric Practice-Review , Md Atiar Rahman
Bronchoscopy is an invasive procedure for examination of air passages and lungs. It helps both for diagnosis as well as interven- tion of airway disease in children and adult. This procedure can be performed by rigid or flexible bronchoscope on the needs of pa- tients and choice of the expertise. It can help direct visualization of airways, to obtain biopsy material, Broncho alveolar lavage (BAL) fluid from lungs and distal airways and help to diagnose various pulmonary diseases. Foreign body removal is another indication of bronchoscopy in children. Recently interventional bronchoscopic procedure has now been developed for treatment of laser therapy, balloon dilatation and stenting of airway in children. Though bronchoscopy is a safe procedure, but sometimes obstruction of airway may require special attention during procedure. The aim of this review is to outline update of bronchoscopic procedure for diagnos- tic, therapeutic and intervention of airway disease in children. Keywords: Bronchoscopy; Children; Airway Disease; Rigid; Flexible; Broncho Alveolar Lavage (BAL)
195 Auto-Immune Inner Ear Disorders: Unheard Dangers , Seejal Shrest
ne reason that steered me fanatical to pen down this module happens to be that it greatly affects large section of population and causes irrevocable damages. The time is not far that it will become common like Diabetes and Hypertension but the incurred dam- age would not be easy to reverse; impacting the persons’ lifestyle, mental and physical health. This module tends to answer all the associated queries that arise out of the patient’s or treating clinicians’ mind as a result of inquisitiveness. The module has four distinct sections for better illustration of the content.
196 Nasal-type Natural Killer/T-cell Lymphoma Occurring at the Site from Which a Sinonasal Inverted Papilloma was Previously Resected: A Rare Case Report , Bo-Nien Chen
Objectives: Sinonasal inverted papillomas (SNIPs) are benign and account for 0.5%-7% of sinonasal tumors. However, SNIPs have the potential for recurrence and malignant transformation. The most common histologic type of malignant transformation of SNIPs is squamous cell carcinoma, and it is rarely associated with other pathological types of malignancy. Herein, we present a unique case of nasal-type natural killer (NK)/T-cell lymphoma occurring at the site from which a SNIP was previously resected. Methods: A 58-year-old male nonsmoker had a left SNIP and underwent tumor excision by the endoscopic approach. Postopera- tively, SNIP recurrence was not observed in routine follow-up. Thirteen years later, at the age of 71 years, he reported blood-tinged discharge from the left nose for 1 month and was diagnosed with nasal-type NK/T-cell lymphoma occurring at the site from which the SNIP was previously resected. He subsequently underwent tumor excision by the endoscopic approach and adjuvant concurrent chemoradiotherapy (CCRT). Results: The patient tolerated treatment for nasal-type NK/T-cell lymphoma well. Recurrence of nasal-type NK/T-cell lymphoma was not observed during 30 months of follow-up after therapy. Conclusion: Based on our research, this is the first reported case of nasal-type NK/T-cell lymphoma occurring at the site from which a SNIP was previously resected. In this case, awareness and early diagnosis, followed by endoscopic excision and adjuvant CCRT, provided good treatment results. This report expands the spectrum of reported SNIP-associated malignancy and emphasizes the importance of considering the malignant transformation of SNIPs and close, prolonged (preferably life-long) follow-up. Keywords: Nasal-type Natural Killer/T-cell Lymphoma; Sinonasal Inverted Papilloma; Endoscopic Surgery; Concurrent Chemora- diotherapy
197 Small Cell Neuroendocrine Carcinoma of the Palatine Tonsil After Concurrent Chemoradiotherapy for Laryngeal Cancer: A Rare Case Report , Bo-Nien Chen1, Chih-Yung Yang and Shiuan-Li Wey
Objectives: Small cell neuroendocrine carcinoma (SCNEC) of the palatine tonsil is extremely rare, highly invasive, and associated with poor prognosis. Herein, we present an extremely rare case of SCNEC of the palatine tonsil after concurrent chemoradiotherapy (CCRT) for laryngeal cancer. We also provide a brief review of its clinicopathological characteristics and treatment modalities. Methods: A 66-year-old Taiwanese woman visited our hospital with a 2-week history of left-sided sore throat. She had a history of laryngeal cancer treated with CCRT 5 years ago. Asymmetric enlargement of the left palatine tonsil with extensive ulceration was noted. Biopsy of the left palatine tonsil was performed, and SCNEC was diagnosed. The patient subsequently underwent surgical intervention (wide excision of the left palatine tonsil and left supraomohyoid neck dissection) and adjuvant chemotherapy. Results: The patient tolerated the treatment well and symptoms resolved. Tumor recurrence was not observed in follow-up mag- netic resonance imaging after therapy at the 12-month follow-up time point, and the patient has resumed a normal life. Conclusion: This report highlights the importance of considering the effect of CCRT on SCNEC occurrence and expands the spectrum of reported radiation-induced neoplasms in the head and neck region. It is critical for clinicians to be aware of this extremely rare and highly invasive malignancy. Keywords: Small Cell Neuroendocrine Carcinoma; Concurrent Chemoradiotherapy; Postradiation Neoplasia; Tonsillar Malignancy
198 Oculomotor Nerve Palsy as Initial Manifestation of Sinonasal Actinomycosis: A Rare Case Report , Bo-Nien Chen
Objectives: Actinomycosis is a rare subacute to chronic infection caused by Actinomyces, a gram-positive, filamentous, non-acid, fast, anaerobic to microaerophilic bacteria. Herein, we present an extremely rare case of sinonasal actinomycosis with an initial manifes- tation of oculomotor nerve palsy. Methods: A 56-year-old man presented to our hospital with a 1-week history of drooping of right upper eyelid, double vision, and right frontal headache. Functional endoscopic sinus surgery was performed bilaterally under endotracheal general anesthesia. The time to surgical intervention following onset of oculomotor nerve palsy was 5 weeks. Antibiotic treatment (ciprofloxacin, 500 mg q12h × 8 weeks) was administered postoperatively for sinonasal actinomycosis. Results: The patient’s right oculomotor nerve palsy and right frontal headache were markedly improved in the first week after sur- gery. The patient had completely recovered from both symptoms 1 month after surgery. Follow-up endoscopy performed at 6 months after surgery revealed no recurrence of sinonasal actinomycosis. Conclusion: This rare case of oculomotor nerve palsy with initial manifestation of sinonasal actinomycosis was amenable to surgical intervention combined with antibiotic treatment and carries an excellent prognosis. Keywords: Actinomycosis; Actinomyces odontolyticus; Sinusitis; Oculomotor Nerve Palsy; Functional Endoscopic Sinus Surgery
199 Mucormycosis- A Post Covid Challenge in India , Amil Sharma, Sonali Lakhani, Hitendra Yadav, Arpit Sikri, Jignesh Agrawal and Arpit Shrivastava
In 2019, an unknown virus known as Covid-19 was discovered in Wuhan, China. The first case of Covid-19 was discovered in India on January 30, 2020. In March 2020 it was declared as a global pandemic by World Health Organization. In 2021 India faced the 2nd wave of Covid-19. Among the patients recovered from Covid19, few developed opportunistic infection with Black fungus also known as Mucormycosis. Diabetes Mellitus was found to be a risk factor in mucormycosis. The main aim of this article is to conduct a detailed review of mucormycosis infection. Keywords: Mucormycosis; Covid 19; Steroids; Diabetes Mellitus
200 Rhinosinusal Mucormycosis in a Post COVID-19 Patient: A Case Report , Ruiz Díaz H, De Castro G, Borche G, Maldonado R and Gustavo Costas Riviezzo
Rhinosinusal mucormycosis is a rare, potentially fatal manifestation with insidious, unspecific clinical manifestations and poor clinical course. In recent months, cases associated with Sars CoV-2 infection have been reported in previously healthy patients. Early surgical treatment has a marked influence on the prognosis. Keywords: Mucormycosis; Covid-19; Oropharynx; Fungal Rhinosinusitis
201 Behavior of Tinnitus and its Impact on Post COVID-19 Patients , Adriana Nora Habbaby
Tinnitus has always been a frequent reason for otological consultation in the general population. Since the appearance of SAR Co- vid-19, recent studies report that in individuals who have suffered from Covid-19, tinnitus may appear as a sequela of the mentioned disease in some cases while in others who already suffered from it, they have worsened. This article also shows the results of a survey carried out in my private clinic to 42 patients in January 2021 to investigate the presence of hearing loss and tinnitus in post-covid patients and if this tinnitus was aggravated or appeared as a sequel. Finally, alter- natives therapies are mentioned that can be useful and at last the Tinnitus Retraining Therapy with the use of hearing aids in order to provide a better quality of life for the patient. Keywords: Tinnitus; Pandemic; Hearing; Hearing Loss; Hearing Aids; SAR Covid-19
202 A Rare Bleeding Disorder and a Precious Surgery: Cochlear Implantation in a Child with Von Willebrand Disease - A Case Report , R Karthikeyan, Akshat Kushwaha, Sabharisan Paramasivam, Arun Alexander, Sivaraman Ganesan and Sunil Kumar Saxena
Von Willebrand disease (vWD) is the most common inherited bleeding disorder with a prevalence of 1 percent [1,2] but only a small proportion of patients come to medical attention because of the mild nature of the bleeding symptoms. The usual clinical pre- sentation is in the form of mucosal bleed, prolonged bleed from minor cuts or trivial trauma or menorrhagia in females [3]. VWD is due to a quantitative or qualitative deficiency in von Willebrand factor (VWF), a complex plasma protein that plays a pivotal role in the control of bleeding by the formation of a platelet plug. Clinical manifestations are highly variable and co-relate with the nature of the deficiency and accordingly, with the management. Here we are reporting one such case of vWD who underwent the major surgery of cochlear implantation. Keywords: Von Willebrand Disease (vWD); Von Willebrand factor (VWF); Cochlear Implantation
203 A Clinical Study on Complications of Chronic Suppurative Otitis Media , Chaitry Shah, Darshan D Parikh, Bela J Prajapati, Achal Pandya, Sreevidya SR and Avinash Shah
Introduction: Chronic suppurative otitis media [CSOM] is a common public health problem in India. Though there is decline in inci- dence of its complications and mortality, they are still frequent due to poor socioeconomic conditions, lack of awareness and unavail- ability of trained specialists in rural region. Objective: Objectives of our study are to diagnose and identify the complications of CSOM, role of radiological investigations in CSOM, management of complications of CSOM and post-operative outcome and results of CSOM. Materials and Methods: It is a prospective study comprises of 50 patients with complications secondary to CSOM admitted in de- partment of ENT civil hospital, Ahmedabad. The study was done over a period from May 2017 to January 2020. Analysis was regard- ing the demographic profile, clinical features and a comprehensive investigation panel related to each complication and management protocol. All the patients with suspected complicated CSOM, according to signs and symptoms underwent computed tomography [CT] and MRI. Results: In this study of 50 patients, 30 patients presented with extracranial complications and 20 patients with intracranial compli- cations of CSOM. Out of extra cranial complication, post auricular abscess and out of intra cranial complications, brain abscess was found to be most common complication. Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma. The intracranial complications presented with fever, headache and signs of meningeal irritation. Conclusion: In this study we emphasize the importance of early diagnosis followed by prompt surgical management as the key in treatment of complicated CSOM. Keywords: Complications; CSOM; Extracranial; Intracranial
204 Real Time Fluoroscopy Guided Extraction of an Impacted Oesophageal Foreign Body: A Case Report , Ukamaka Nwankwo
The incidence of children swallowing foreign bodies or items is high because of their exploratory tendencies. Sharp or large for- eign items can get impacted in the oesophagus with associated complications. Duration of impaction and poor visualization of the foreign item may make the extraction process difficult. This is a case report of the management of a 9-year-old boy with 6 days history of oesophageal foreign item impaction. He had emergency rigid oesophagoscopy with real time fluoroscopy guided extraction of the foreign body. This report highlights the advan- tage of using real time fluoroscopy in the extraction of impacted, metallic, foreign items. Keywords: Foreign Bodies; Real Time Fluoroscopy; Oesophagus; Impacted
205 Case Report on Binder Syndrome , Prishni Devi Dutta and Swagata Khanna
Binder syndrome or Maxillonasal dysplasia is a congenital malformation. Presenting a case report of 15 year old patient with his- tory of flat nose, who was unhappy with his appearance. He underwent augmentation rhinoplasty and conchal and rib cartilage was used for reconstruction. The surgery was aimed at correction of nasal deformity focusing the patients main complain, to increase the dorsum and tip. Keywords: Binder Syndrome; Maxillonasal Dysplasia; Congenital Malformatio
206 A Case Study on Mucor Septicus (Yellow Fungus) in Post Covid Era , Brajpal Tyagi, Niyati Dhawan and Praveen Kumar Tyagi
Mucor Septicus is rare fungal disease found in post COVID immunocompromised patient. It is known to produce septecemia if not treated timely. A case of same disease discussed first time in human from Reptiles. Keywords: Mucor Septicus; COVID-19; Delta Varian
207 Acquired Phlebectasia of the Internal Jugular Vein in a Patient with Sjögren's Syndrome. An Unusual Accidental Finding , Solano Nicolás, Parra Enmanuel and Sarcos Betsabe
Internal jugular vein phlebectasia is a rare condition, presenting as a unilateral and usually painful neck swelling, mostly affecting the right side of the neck. The acquired subtype of internal jugular vein phlebectasia frequently affects adults and may be caused by trauma, thoracic outlet syndrome, tumors, local or systemic inflammatory conditions. Complementary tests are necessary to confirm the diagnosis. Imaging studies, such as eco-doppler, reveal the venous flow state and contrasted CT scans allow for the differentia- tion between solid tumors and vascular lesions. The purpose of this case report is to present an unusual case of an acquired internal jugular vein phlebectasia in a patient with Sjögren’s Syndrome, presenting it as a chance finding and analyzing a possible mechanism to associate both entities. Keywords: Vascular Malformations; Diagnostic Imaging
208 Comparison between Treatment Outcomes of Titanium Miniplates and Titanium Lag Screws in Fixation of Mandibular Symphysis and Parasymphysis Fractures , Udit Prakash, Moin Iftikhar Shapoo, Peyush Pratap Singh Sikarwar, Bhavika Pol Vhatkar, Ayush Garg and Priya Yadav
Introduction: For a long time Champy’s Miniplates and Lag screws remained as primary methods of fixation of mandibular fractures. Both miniplates and lag screws have their specific advantages. This prospective study was conducted to compare the efficacy and surgical outcomes of treatment of mandibular fractures using either titanium miniplates or titanium lag screws for internal fixation. Materials and Methods: 200 patients were selected for the study and they were evaluated pre and post-operatively on various parameters. Patients were divided equally into two groups. One group was treated with titanium miniplates (group M) and other group by titanium lag screws (group L). Operating time was recorded and post-operative complications were observed over regular interval of time. Results: Mean preoperative distance at various points on fracture line in group M was 1.7930, 2.6440, 2.4330 respectively while in group L it was 2.7560, 2.4950, 2.2230 respectively. There was significant decrease in distance between fracture segments post- operatively. The mean operative time for titanium lag screw fixation was 80.10 mins while for miniplates it was 100.50 mins. Post- operative complications were less in group L when compared to group M. Conclusion: Lag screw has definite advantage over miniplates in terms of time duration of surgery, proper reduction and postopera- tive complications. Keywords: Titanium Miniplates; Titanium Lag Screws; Mandibular Symphysis; Parasymphysis Fractures
209 Comparison between Treatment Outcomes of Titanium Miniplates and Titanium Lag Screws in Fixation of Mandibular Symphysis and Parasymphysis Fractures , Udit Prakash, Moin Iftikhar Shapoo, Peyush Pratap Singh Sikarwar, Bhavika Pol Vhatkar, Ayush Garg and Priya Yadav
Introduction: For a long time Champy’s Miniplates and Lag screws remained as primary methods of fixation of mandibular fractures. Both miniplates and lag screws have their specific advantages. This prospective study was conducted to compare the efficacy and surgical outcomes of treatment of mandibular fractures using either titanium miniplates or titanium lag screws for internal fixation. Materials and Methods: 200 patients were selected for the study and they were evaluated pre and post-operatively on various parameters. Patients were divided equally into two groups. One group was treated with titanium miniplates (group M) and other group by titanium lag screws (group L). Operating time was recorded and post-operative complications were observed over regular interval of time. Results: Mean preoperative distance at various points on fracture line in group M was 1.7930, 2.6440, 2.4330 respectively while in group L it was 2.7560, 2.4950, 2.2230 respectively. There was significant decrease in distance between fracture segments post- operatively. The mean operative time for titanium lag screw fixation was 80.10 mins while for miniplates it was 100.50 mins. Post- operative complications were less in group L when compared to group M. Conclusion: Lag screw has definite advantage over miniplates in terms of time duration of surgery, proper reduction and postopera- tive complications. Keywords: Titanium Miniplates; Titanium Lag Screws; Mandibular Symphysis; Parasymphysis Fractures
210 Acute Parotitis: An Atypical Manifestation of Covid-19 , Vaishnavi Kavirayani
While the Coronavirus disease (COVID-19) commonly presents with respiratory symptoms, there has been a rise in the number of atypical manifestations with the unfolding of the pandemic. Acute parotitis is one such atypical manifestation associated with CO- VID-19. It is important that physicians familiarize themselves with these atypical symptoms in order to prevent infection and disease transmission. It is important that COVID-19 be considered in the differential of parotitis and other virus-causing syndromes, as well as emphasize on the importance of personal protection during initial examination. Keywords: COVID-19; Coronavirus; Acute Parotitis; Atypical Manifestation; Salivary Gland
211 Vocal Hygiene Tips: For Mothers of Infants and Toddlers , Saravanapriya R
It gives me immense pleasure to write this guest editorial for this upcoming July issue of the Otorhinolaryngology journal. Being a speech-language pathologist and a first-time mom of a 7-month-old baby makes me relate my professional knowledge to my personal experiences.
212 Olfactory Abnormalities and COVID; An Analysis of Hundred Cases , Minutha R, Sriram Nathan
Introduction: With the recent pandemic of COVID Severe acute respiratory syndrome or SARS on the rise especially in the city, there has been an increase in the number of patients especially in the ENT out patient department with diagnosis of COVID. A common symptom of COVID and now a major symptom for diagnosis was the presence of loss of smell and taste to varying degree. We examined those patients with proven diagnosis of COVID and analysed the symptoms of Anosmia or Hyposmia in them. This is a short term study of three months where we analysed the patients encountered by the author in the time period. Over one hundred patients were encountered during this period and their assessment in respect to COVID was done and results presented. Some patients were seen in the out patient department, some in the operation theatre and during assessment as part of COVID triage. Materials and Methods: Patients were screened for common symptoms of COVID with special emphasis on olfactory anomalies and followed up. Observation: Olfactory symptoms were seen in a high number of patients (over 40 percent); this could be partially since the ENT practice will encounter these symptoms first. Conclusion: The study makes the conclusion that this is an established fact that Olfactory anomalies especially sudden Anosmia is an important indicator of COVID infection. Further evaluation is needed for the pathophysiology and treatment protocols and this will be more clear in the coming months. Keywords: COVID; Hyposmia; Anosmia
213 Etiopathogenesis and Prognosis of Altered Taste and Smell Sensation in Covid 19 Patients , Rashmi Nambiar, Sumit Sharma and Suvarna Sharma
Altered taste and smell sensation is being reported commonly in Covid patients. Human strains of corona virus have been dem-onstrated to invade the central nervous system through the olfactory neuroepithelium and propagate from within the olfactory bulb. Nasal epithelial cells display the highest expression of the SARS-CoV-2 receptor, angiotensin converting enzyme 2, in the respiratory tree. The condition is more commonly associated in patients with mild disease. Initially there were concerns that the virus can reach the brain through olfactory bulb but post-mortem studies of people who had had COVID-19 have shown that the virus rarely reaches the brain. According to the OLFACAT survey, loss of smell, either hyposmia or anosmia was seen in virtually 2 hundredth of the Eu-ropean general population. Loss of smell is taken into account to possess a major impact on quality of life. The article is aimed to summaries the Incidence; causes and recovery pattern of the Covid associated altered taste and smell sensation. WE concluded that Anosmia may be thought to be an unknown neurologic symptom in COVID-19. Within the early stage of the disease anosmia and ageusia appear to be a part of vital symptoms and clues for diagnosing COVID-19. The acute onset of loss smell and loss of taste appear to be the vital symptom of SARS Cov-2 which may improve at an interval of 3 weeks. Keywords: Altered Taste; Altered Smell; Covid 19 Patients
214 Role of Histopathological Correlation in Cases of Sino-Nasal Masses: A Retrospective Analysis , Ayushi Gupta, Sahil Kapoor, Poonam K Saidha, Pooja Das and Arun Kumar
Objectives: Sinonasal masses affect people of all age groups and cause significant impairment of quality of life. The present study aimed to assess the clinico-pathological profile of patients presenting with sino-nasal masses and emphasize the role and importance of pre-operative histopathology of their sino-nasal masses. Methods: Fifty five patients (10 - 68 years age) presenting to a tertiary care centre in Gurugram, Haryana with sino-nasal masses over the course of 3 years were included in a retrospective analysis. All masses were sent for histopathological examination for final diagnosis prior to surgical intervention. Results: The most common presenting complaint was nasal obstruction (38%). Ninety percent of sino-nasal masses were found to be benign, of which, nasal polyp (40%) was the most common biopsy finding. Amongst malignant lesions, squamous cell carcinoma (60%) was the most common histological type. Conclusion: Correlation of clinical and histopathological finding is of utmost importance for accurate and timely diagnosis of sino- nasal masses. It will enable prompt and better management of these patients, which will decrease morbidity and mortality associated with sino-nasal masses. Keywords: Sinonasal Mass; Histopathology; Nasal Polyps; FESS
215 Confrontation Naming and Generative Naming in Dementia: A Comparison , Deepthi Vivek V and Amirtha Varshini MJ
The Picture naming test is a widely accepted method to assess the cognitive deterioration in patients with Dementia. It is pre- sumed to require access to semantic memory and so would be a valuable tool in analysing the nature of semantic deterioration. Language functioning and social performance has been to gradually decrease with progression of the disease. The aim of this study was to identify the differences between confrontation naming and generative or divergent naming in patients with dementia of Al- zheimer’s type and to provide insight into the representations within semantic memory. Both of these naming tasks have been found to be effective in identifying dementia as well as provide insight into the progression of the disease. Confrontation naming involves direct selection of a semantic memory category in response to a visually presented stimulus. Divergent naming includes accessing a multitude of words that are triggered by the presentation of auditory stimuli. The confrontation naming task used was picture nam- ing and the generative or divergent naming task was verbal fluency task. The current study considered a control group (30) and an experimental group with age and gender matched individuals (30). The picture naming task consisted of 20 pictures of commonly used everyday objects. Category Fluency Task with Subtask I (living) and subtask II (non-living) was used. There was a noticeable difference in performance in both tasks between the control group and experimental group. It is also important to note that the experimental group performed significantly lower in the divergent naming task compared to the confrontational naming task. This might be attributed to the presence of the visual stimuli contributing as a cue in the confrontation naming task. Divergent naming or Category fluency necessitates the recall of multiple responses from a hierarchically and categorically organised information. This indicates that naming tasks can be used to identify semantic deterioration, thereby aiding in the early diagnosis and intervention of individuals with Dementia. Keywords: Dementia; Naming; Semantic Memory; Confrontation naming; Divergent Naming
216 Noise Induced Hearing Loss in Indian Railway Travelling Ticket Examiners , Athira Rajan, Srikanth Nayak, Lidiya Mathew, Rahana Shiju and Sathish Kumar
Background: Railway Travelling Ticket Examiner (TTE) is an employee in Indian railways who examines ‘passenger’s tickets during the journey in trains. TTEs are more susceptible to noise-induced hearing loss as they work for around 8 hours per day on the train and have continuous exposure to loud noise during their working hours. So, the present study aimed to assess the hearing sensitivity of the Indian Travelling Ticket Examiner. Materials and Methods: The study included thirteen railway TTEs for hearing assessment. The hearing sensitivity was assessed by obtaining a detailed case history, otoscopic examination, pure tone audiometry and tympanometry. Results: The mean pure tone average was 22.5 ± 6.03 dBHL and 19.42 ± 7.06 dBHL in the right and left ear, respectively. All the sub- jects had minimal to mild sensorineural hearing loss in both ears. The degree of hearing loss increased at high frequencies (4 and 8 kHz). Conclusion: The affected hearing thresholds in TTEs depicts a significant correlation between their service experience and hearing loss. The positive correction between TTEs work experience and hearing loss may lead to a handicapping situation in their profes- sional and personal life. Hence the enrollment of railway TTEs in an appropriate and effective Hearing Conservation Program is a necessity. Keywords: Railway Travelling Ticket Examiner; Noise Exposure; Noise-Induced Hearing Loss; Puretone Audiometry; Hearing Con- servation
217 The Otic Outcrop-Inflammatory Aural Polyp , Anubha Bajaj
Aural polyp manifests as a polypoid, non-neoplastic prolifera- tion of granulation tissue admixed with an inflammatory cellular exudate. The polyp arises due to inflammation induced polypoid proliferation predominantly arising within the middle ear mucosa, usually as a consequence of chronic otitis media. Commonly, aural polyp emerges within the middle ear cleft and appears as a reac- tion to persistent, localized inflammatory mechanisms as encoun- tered with chronic otitis media or associated conditions.
218 The Aural Canker-Ceruminous Adenocarcinoma , Anubha Bajaj
Ceruminous adenocarcinoma is a commonly discerned en- tity, in contrast to benign neoplasms of the ceruminous gland. Malignant neoplasms of the ceruminous gland are designated as “ceruminous adenocarcinoma” by the world health organization (WHO). In descending order of frequency, ceruminous adenocar- cinoma is categorized into adenoid cystic carcinoma, ceruminous adenocarcinoma- not otherwise specified (NOS) and mucoepider- moid carcinoma.
219 Retropharyngeal Space Hematoma in a Patient with Severe COVID-19 Illness , BV Manjula
Background: Deep neck spaces include prevertebral, danger and retropharyngeal spaces. Imaging cannot differentiate between these various fascial planes. A hematoma in these potential spaces due to any reason can compress the airway leading to stridor, dyspnea, neck pain and dysphagia. Most of these hematomas resolve within 2 weeks but few would require intervention depending on severity of symptoms. Case Description: A 53 years old female patient was mechanically ventilated and tracheostomized for severe COVID-19 illness. She developed throat pain, swallowing difficulty and difficulty in neck movements, which were noticed after she was shifted to the ward. She was referred to the ENT department for endoscopic evaluation and imaging which suggested a large retropharyngeal collection. She underwent intraoral aspiration and drainage of hematoma after which her symptoms resolved. Conclusion: Individualized approach is needed for these rare conditions and sometimes a simple procedure may be sufficient to ad- dress a major, possibly life threatening condition. Keywords: Retropharyngeal Hematoma; Prevertebral Space; Dysphagia; Airway Obstruction; Anticoagulants
220 Randomized Double Blind Study for Detecting Association of Globus Pharyngeus with Dietary and Daily Habits of North Indian Population and Formulating a Uniform Treatment Plan , Abdul Rehman Khan, Mohammad Aftab, Nizamuddin Sheikh and Nitin khari
Aims: Globus pharyngeus is a painless sensation in throat, described as a foreign body sensation, a tightening or choking feeling. Often associated with persistent clearing of the throat, cough, and change in voice. It makes up 4% of ENT referrals and is reported to have been experienced by up to 46% of the population. This study was done to redefine etiological factors and formulate a plan of treatment. Methods: All the consecutive patients who were having specific symptoms of foreign body sensation, vague pain and discomfort in upper digestive tract or throat were included in this study, during the 3.3 years period from 2018 January. After applying inclusion and exclusion criterias and considering consent for endoscopy 587 patients were included in the study. A uniform questionnaire was devised and all the patients were asked the same questions from the questionnaire and a proforma was filled. Patients were divided in 3 groups in 1:1:1 pattern and Group A was given placebos, Group B was give Treatment regimen as per study and Group C was given Treatment regimen plus psychotherapy, voice/speech therapy and physiotherapy. All the groups were randomized and double blinded. Statistical analysis was performed and fisher exact test and chi square tests were used to detect significance and scope of null hypothesis. Result: Most common etiological factors involved were repeated dry swallowing of saliva, going to bed late at night and intake of some specific foods which may point to some allergic cause, though it varies from place to place. In 10% of cases some psychological factor was also responsible. Treatment plan C was having most significant response, Fisher exact test and chi square tests were done for statistical analysis. The p-value is < 0.00001. The result was significant at p < .01. Conclusion: Treatment plan B and Treatment Plan C significantly improved symptoms of globus pharyngeus as compared to Plan A (placebo) group. Keywords: Globus Pharyngeus; Dietary; Daily Habits
221 A Case Series of Rhino-Orbital Mucormycosis in COVID-19 Patients , K S Dinesh and R Vanitha
Mucormycosis is caused by filamentous fungi of Mucor, Rhizopus, Absidia, Apophysomyces, Saksenae and Cunninghumella of the Mucorales order. Mucormycosis was first described by Paultauf A in 1885. Neutrophils play a key role in the host defence against mucormycosis. Ketoacidosis, hyperglycemia and hypoxia are excellent growth conditions for mucormycosis. Impairment of phagocy- tosis due to immunosuppression causes germination of spores into hyphae resulting in angio-invasion. Recently, the surge in mucor- mycosis is linked to the second wave of COVID-19 infection mostly due to uncontrolled diabetes in patients managed with steroids. India has emerged as being the mucormycosis capital in recent times. In this study report, we present the clinical findings and therapeutic outcomes of rhino-orbital mucormycosis in 3 male patients, age range between 45 - 75 years old all had diabetes mellitus and underwent treatment for COVID-19 pneumonia. All patients developed proptosis, sinusitis and decreased visual acuity with no light perception in the two patients with severe orbital involvement. Histopathological examination of tissue biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; one patient had complete recovery. All 3 patients underwent functional endoscopic sinus surgery (FESS) with orbital decompression and one patient needed orbital exenteration. One patient died after declining systemic treatment postoperatively. Early diagnosis and intervention with antifungal medication and surgical clearance of the disease may help avoid mutilating surgery like exenteration. Basic safety precautions like proper use of mask, single use of oxygen tube, using distilled water, hand washing and social distancing will go hand in hand to prevent the fulminant nature of the disease. Long term monitoring of patients is essential for favorable outcome. Keywords: Mucormycosis; COVID-19; Diabetes Mellitus; FESS; TRAMB
222 Cervical Localization of a Mature Pluritissular Teratoma: Case Report , Ngouoni Gérard Chidrel, Otouana Dzon HB, Itiere Odzili FA, Diembi Sylvain, Mouamba FG, Peko JF and Ondzotto G
The teratoma is a tumor originating from pluripotential cells and composed of a great diversity of tissues foreign to the organ. Its cervical localization is rare. The management remains surgical in order to avoid complications and reduce the risk of malignant transformation. We report a case of low cervical localization in an 11-year-old girl. Clinical examination and ultrasound of the tumour evoked goiter. The histopathological results, after total excision of the operating room, concluded to a mature pluritissular teratoma. The rare possibility of a recurrence of this benign tumor justifies a long-term follow-up of this young patient. Keywords: Teratoma; Cervical; Mature; Pluritissular
223 Uncorrectable Dimensions in Congenital Canal Atresia Making Us to Revise Operative Candidacy and Patient Selection , Wael A Alzamil
Background: Congenital aural atresia is common birth defects and is often associated with au ricular and middle ear deformities. The external auditory canal anomaly varies from slightly narrow to complete atresia. Congenital external auditory canal steno sis is defined by Jahrsdoerfer., et al. as an EAC with a diameter of less than 4 mm [1]. The surgical management for canal atresia and steno- sis is aimed to improve hearing and establish an appropriate auditory canal status for possible application of hearing aids. In clinical practice, we found that patients with canal stenosis and partial atresia have a better postoperative hearing improvement and few er postoperative complications than those with complete canal atresia [2]. By analyzing the temporal CT images and intraoperative findings in patients with canal atresia and comparing those with images and intraoperative findings from normal canals, we further understand ex ternal and middle ear development to improve surgical candida cy selection and avoid unnecessary complications [3]. In addition to the status of the ossicu lar chain, the degree of development and pneumatization of the tympanic cavity and mastoid, and the course of the facial nerve, the most important information taken from CT and intraoperative findings are the dimensions of the proposed future canal. There are main three dimensions which are the lateral and medial canal diameters and the depth of the canal. Each diameter has two main diagonals, the antero posterior dimension and the supero inferior dimension. This study will focus on the dimensions of the created canal or cavity and whether it is correctable or uncorrectable. Aim of the Study: To match the C.T. scan and intraoperative findings with the surgical outcome for patients with congenital canal atresia and illustrate the operated uncorrectable dimensions with unfavorable outcome for later proper patient selection and surgi- cal candidacy considerations. Patients and Methods: A prospective, study conducted from September 2017 to December 2020 on 50 patients suffering congenital canal atresia. Patients have been subjected to preoperative audiological assessment and high resolution C.T. scanning. All patients ad- dressing the study have been scored according to the Jahrsdoerfer Grading Scale selecting patients with scores above 6 (50 patients). All patients have undergone surgical meatocanaloplasty via anterior approach or posterior approach according to the C.T. findings. Intraoperative data collection was done to be matched with preoperative C.T. data and correlated later on with the final outcome. Postoperative regular follow up visits were done obligatory every two to three weeks for at least six months and for regular packing. Results: Data collection was done involving intraoperative anatomical findings, difficulties or complications, immediate and late postoperative results including the final outcome. Intraoperative measurements have showed marked reduction of the depth of the cavity or the created canal ranging from 1 to 1.5 cm in 47 operated ears having complete atresia and more favorable depth ranging from 1.75 to 2.25 cm in the last three patients with C.T. evidence of partial atresia and less affected tympanic ring. Regarding the antero-posterior distance of the cavity, it was doubled and tripled after radical mastoidectomy in the 47 patients of complete atresia
224 A Rare Case of Parotid Abscess Associated with Facial Nerve Palsy , Harjitpal Singh, Amit Saini, Bharti Ranot, Trilok Guleria and Ravinder Kaur
Parotid infection/abscess leading to facial nerve palsy is an extremely rare complication. Normally, malignant parotid mass is associated with facial nerve palsy. We present a case of parotid abscess which was complicated by facial nerve dysfunction and had very late recovery. Keywords: Parotid Mass; Facial Nerve Palsy; Parotid Abscess
225 Bilateral Fallopian Canal Meningocele: Case Report and Literature Review , Vito Pontillo and Nicola Quaranta
Meningocele of the fallopian canal is assumed to be related to a defective ossification of the Facial Canal and to a subsequent dila- tation of the subarachnoid space within this canal. We bring our personal experience with a singular case of bilateral fallopian canal meningocele of a 48-year-old woman with a history of right otogenic meningitis. Considering the high risk of iatrogenic CSF fistula or facial palsy, it was decided to proceed by exclusively treating the right meningocele, while monitoring the left side. We carried out a subsequent analysis of the literature in order to verify the accuracy of our strategy. A comprehensive search was conducted in PubMed from January 1, 1966, through December 31, 2020. To the best of our knowl- edge, 25 cases of fallopian canal meningocele were reported in the literature thus far, and only one of them with bilateral presenta- tion. All the surgical strategies were analysed. Surgical approach to this condition must be tailored to the single case, especially in the unlikely circumstance of bilateral pres- entation. We propose our treatment strategy to this rare condition, in the lights of the literature debate and our personal experience. Keywords: Bilateral; Fallopian Canal; Facial Canal; Meningocele
226 Hearing Assessment is Not that Easy , Zahraa Mohamed Yousry Khaled Elbohy
Hearing assessment is not that easy as it seems to be for most of people including otolaryngologists and even audiologists. Con- cerning pure tone audiometry (PTA), using the pure tone signal is not realistic. It is not the daily stimulus in our real life. Speech au- diometry does not represent the real life situation too.
227 Effectiveness of Multimodal Intervention on Audiological and Psycho-Social Profile of Meniere’s Disease: A Case Study , Pragnya P Prusty, Santosh Kumar Swain, Satyabrata Panigrahi, Sibananda Mishra and Ramkrishna Pattanayak
Meniere’s disease (MD) is a chronic disorder of the inner ear that is characterized by intermittent attacks of loud tinnitus, a sense of pressure in the ear, vertigo and progressive permanent hearing loss in one or both ears. Anxiety and dizziness occur as co-morbid symptoms in a larger percentage of patients than would be expected from chance alone. The individual profile of Meniere’s disease in different patients makes it difficult to diagnose on the basis of symptomatology alone. The impact of Meniere’s disease on qual- ity of life has highlighted the importance of an additional approach to support the diagnosis andintervention of Meniere’s disease. In this study, we discussed about the interface between Meniere’s disease, its audiological manifestations and psycho-social factors influencing the Quality of life.
228 Dysphagia Caused by Two Possible Culprits - Diverticulum or Osteophyte , Brian Walker, Naresh Patel and William Karle
Killian-Jamieson Diverticulum (KJD) is a rare and often misdiagnosed esophageal diverticulum with a wide variability of presentation and treatment options. We report the first case of KJD treated with cervical osteophytectomy in addition to transcervical diverticulectomy. A 76 year old male presented with a history of dysphagia with KJD and imaging findings of cervical osteophytes directly adjacent to the diverticulum. He was able to resume oral intake on post- operative day one and reported significant improvement in symptoms at follow-up.It is therefore important to consider extra-esophageal contributions to diverticulum development. Transcervical diverticulectomy with osteophytectomy is a safe and effective method of managing KJD.
229 Characterizing the Effects of Site-Specific Metastases on Nasopharyngeal Squamous Cell Carcinoma Survival , Christopher C Tseng, Jeff Gao, Gregory L Barinsky, Jordon G Grube, Christina H Fang, Jean Anderson Eloy and Wayne D Hsueh
Introduction: To investigate the impact of site-specific metastases on survival and identify predictors of metastasis in patients with nasopharyngeal squamous cell carcinoma (SCC). Materials and Methods: The National Cancer Database was queried for all cases of nasopharyngeal SCC between 2010-2016 which had metastasized to distant sites (460 cases). This was then further classified as metastases to bone, liver, lung, brain, and multiple sites. Univariate and multivariate analyses were used to compare patient demographics between sites. Kaplan-Meier analysis was applied to compare overall survival.
230 The Feasibility of Ultrasound to Assess Structural Anatomy of the Larynx , Sharma Nitu, Gnawali Suman, Poudel Shivaji, Lino Santiago S Pabillo, Chila Deguito and Yadav Ajay Kumar
Ultrasonography (USG) has been proven to be a fast, easily available, and cost-effective diagnostic tool in evaluating various organs of the body, however, its use in the evaluation of the larynx has not been popular. In this cross-sectional quantitative study 71 healthy volunteer, 20 - 40 years of age got ultrasound with linear transducer (7 - 13 MHz) in B-mode. Obtained data were analyzed using SPSS ver.20 software and shown in frequency, percentages and bar diagram. The mean length of Laryngeal Inlet, Glottis and Tracheal Air Column is 1.049, 0.630, and 1.131 respectively in female. In male the mean length of Laryngeal Inlet, Glottis and Tracheal Air Column is 1.22, 0.70 and 1.34 cm respectively
231 Delay in the Care of Non-COVID-19 Patients Amid the Ongoing Pandemic: The Predicament of a Clinician , Dipika Prakash, Neha Chauhan and Darwin Kaushal
COVID-19 pandemic has resulted in severe social and economic impacts around the globe. It had a major impact on the healthcare systems posing a great challenge to the efficient delivery of healthcare services to the public. The authors hereby want to highlight the predicament faced by the healthcare workers in treatment of patients suffering from non-COVID diseases.
232 “Because of Them I will Never Give up”: Perspective of Patients Receiving Specialist Palliative Care in the Kumasi Metropolis, Ghana , Gladys Anyane, Rasheed Ofosu-Poku, Michael Owusu-Ansah and Alberta Delali Dzaka
The global need for palliative care continues to grow as a result of the rising burden of non-communicable diseases and an ageing population. Each year, an estimated 40 million people are in need of palliative care. The aim of palliative care is to improve the quality of life of individuals and families who are faced with life-threatening illness, and to offer a support system which helps patients live as actively as possible until death. This study aims at discovering the perspective of patients receiving specialist palliative care at the Komfo Anokye Teaching Hospital
233 Pleomorphic Adenoma of Parotid Gland , Anil M Shinde, Rajwardhan A Shinde and Himanshu Soni
Pleomorphic Adenoma is most common benign neoplasm of the major and minor salivary glands. It is predominantly affect the su- perficial lobe of the parotid gland. Pleomorphic adenoma is an asymptomatic swelling which gradually increases in size if not treated. The neoplasm has a female predilection between 30-60 years of age. The aim of this case report is to discuss clinical manifestation, diagnosis and treatment plan of pleomorphic adenoma of the parotid gland. A case of pleomorphic adenoma in an 46 years old male, who presented with asymptomatic firm fluctuant swelling in right pre-auricular region. The lesion was examined clinical, histopat- hological and investigations were carried out. FNAC showed benign salivary gland elements consistent with pleomorphic adenoma. Superficial parotidectomy was done with adjacent free margins, taking care not to injury the branches of facial nerve. Post recovery was uneventful with no defect of facial nerve function. This case report highlights the need for proper diagnosis and treatment plan in the cases of benign tumours.
234 The Heteromorphic Gob-Keratosis Obturans , Anubha Bajaj
Keratosis obturans is an exceptional, occlusive disease of the external auditory meatus. Characteristically, anomalous accumulation of a wedge of desquamated keratin within the ear canal is delineated. Keratosis obturans is accompanied by accumulation of lamellar keratinaceous debris which distends and obstructs the external auditory canal with consequent occlusion and expansion of bony segment of the external auditory canal.
235 Comparison of Distribution of Mast Cells in Leukoplakia and Oral Squamous Cell Carcinoma - A Retrospective Study , Himani-Tiwari Chaturvedi and Vandana Shah
Oral leukoplakia and oral squamous cell carcinoma (OSCC) are the commonly occurring oral diseases, with characteristic clinical and histological features. These diseases at some stages are associated with chronic inflammation in adjacent connective tissue. Mast cells are granule-containing secretory cells which are local residents of the connective, scattered along the capillaries of oral mucosa. They are proinflammatory and expressed the serine proteases, tryptase and chymase along with cytokines and may play a significant role in the pathogenesis of oral diseases. The aim of the study was to histologically evaluate and compare the presence of mast cells in Normal mucosa, Leukoplakia and Well differentiated oral squamous cell carcinoma. Thirty cases each of normal oral mucosa, oral leukoplakia, and oral squamous cell carcinoma (OSCC) were studied for mast cell number using 1% Toluidine blue. There was a lin- ear increase in mast cell numbers were seen in leukoplakia and OSCC as compared to normal mucosa. Mast cell hyperplasia in oral leukoplakia and OSCC suggests their probable role in the pathogenesis of these diseases.
236 Fogarty Catheters-An Important Asset in Rounded Airway Foreign Bodies-A Case Report , Nitya Subramanian, Shweta Gogia and Alok Agarwal
Foreign bodies of the airway present a life threatening situation especially in small children. The gold standard procedure for extraction of tracheo-bronchial foreign bodies has been rigid bronchoscopy. Certain foreign bodies with round and smooth surface pose a significant challenge to the bronchoscopist as these objects are tough to retrieve using conventional grasping forceps available. We present the case report of an 8 year old boy who aspirated a round plastic cylindrical bead lodged in the right main stem bronchus. Following unsuccessful attempts at removal by available instruments, the foreign body was removed safely using Fogarty balloon catheter with minimal trauma. We conclude that Fogarty catheters are an important and suitable alternative for removal of rounded foreign bodies in the airway. These catheters should be considered as an important part and asset of the armamentarium of a practicing bronchoscopist.
237 Newborn Hearing Screening and Early Intervention in Indian Context , Seejal Shrest and Bikramjit Pradhan
Joint committee on infant hearing: The Joint Committee on In-fant Hearing was established in late 1969 and composed of Audi-ologists, Otolaryngologists, Paediatricians, mainly. It had people from American Speech and Language Hearing Association (ASHA), the then American Academy of Ophthalmology and Otolaryngology (AAOO) and American Academy of Paediatrics (AAP). Their pivotal roles were making standardized recommendations concerning the early identification of children with or at-risk for hearing loss and newborn hearing screening. Currently the Joint Committee is comprised of representativesfrom the American Academy of Pae-diatrics, the American Academy ofOtolaryngology and Head and Neck Surgery, the American Speech Language HearingAssociation, the American Academy of Audiology, the Council on Education of the Deaf, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies [5].
238 Bacterial and Viral qPCR Data in Chronic Sinusitis , Rithik Rajasekar, Chetan Shah, Rakesh B Patel, Samir Undavia, Gregory Smith, Michael P Ondik and Nishant Reddy
Many studies have investigated the flora associated with chronic sinusitis, but few compare real-time quantitative polymerase chain reaction (qPCR) data with the medical literature. The purpose of this study is to explore our current qPCR data as well as con- duct a literature review on the clinical importance of microbiologic identification techniques such as qPCR and culturing. This study uses qPCR data from a sample set of 333 patients to conduct a comparative analysis. The study found that the three most prevalent sinonasal bacteria in sinusitis are Staphylococcus aureus (Cumulative: 70 positive samples and 21.02% identification rate), Klebsiella pneumoniae (Cumulative: 28 positive samples 8.41% positive identification rate), and Haemophilus influenzae (Cumulative: 20 posi- tive samples and 6.00% positive identification rate) in our patient population. These findings differ from the pathogens traditionally cited in the otolaryngology medical literature. Furthermore, 29.73% of the samples contained non-bacterial pathogens, supporting the use of identification techniques such as qPCR. Ultimately, qPCR identification has helped avoid the inappropriate use of antibiotics.
239 , Fungus Cerebri - A Case Report
K Krishna Kumar and VJ Niranjana Bharathi
240 Myringotomy with Grommet and Dexamethasone Instillation as a Treatment for Sudden Sensorineural Hearing Loss (SNHL) , Sriram Nathan and Minutha R
Sudden sensorineural hearing loss is a common problem in a busy ENT practice. Although many investigations are done, most of the cases, the cause is not known or properly diagnosed. Steroid either oral or injectable either IV or intratympanic is the chief modality of treatment. The common practice is to give intratympanic injection of steroid which is both painful and cumbersome to patients who after the experience of the initial instillation are frequently averse to repeat the procedure over and over again with variable signs of improvement in hearing. We have been averting this whole situation of frequent injection by placing a grommet via a small one time procedure. The steroid is then instilled via drops which is both safe and painless to the patient