Indian Journal of Otolaryngology and Head and Neck Surgery最新文献

Meniere's Disease is a rare ear disorder that can cause severe morbidity to the patient and has no definitive treatment to date. Endolymphatic hydrops is the critical event. Though symptomatology is well understood, the exact etiology of Endolymphatic hydrops attack is still unclear. Twenty-five consecutive patients of Meniere's Disease diagnosed in the Vertigo clinic aged 12 to 70 years were included. Their allergic status was evaluated using a skin prick test. Allergic and non-allergic patients were then identified. Comparison between the two groups was made to identify the effect of allergy on the severity of symptoms using vertigo scales, Functional level scale, Dizziness handicap index, and Pure tone average staging. The prevalence of allergy among Meniere's Disease patients was 56%. The most common allergen found in our study was tyrophagus(n = 8). Polysensitization was more common(n = 12). Airborne allergens were more common than food allergens. There was no significant relationship between the severity scales and the allergen positivity status (p > 0.05). The prevalence of allergy is more among patients with Meniere's Disease. The Endolymphatic sac is allergy prone. The occurrence of endolymphatic hydrops may be due to a cross-reaction of allergen-induced IgE antibodies to self-antigen. Management of the specific allergen may help decrease symptomatology in these patients. Allergen-specific therapies have a promising role in the treatment of allergic conditions and provide a long-term symptom-free period in affected individuals. This can be applied in patients with Meniere's Disease having associated allergic features based on their skin prick test results.

Background: As the incidence of head and neck cancer continues to rise, the volume of referrals to our urgent suspected cancer clinics continues to rise with it. Cancer referral and review time targets are not being met within the UK, and our centre has experienced an increase in volume of referrals which cannot be met by available clinic slots. We proposed a pathway to the North East London Cancer Alliance to safely triage these patients using the Head and Neck Cancer Risk Calculator version 2 (HaNC-RCv2).

Methods: All 2-week-wait referrals to our unit in June 2023 were initially triaged in a telephone consultation by a specialty registrar working in the department. A brief history would be taken, and a risk score calculated. Those scoring < 5% were moved to routine or less urgent follow up.

Results: 120 patients were referred to our department. We were able to safely triage 48.7% patients off the urgent suspected cancer pathway and to routine follow up. A total of 3 patients were found to have a head and neck malignancy and all were treated within the 62 day window.

Conclusion: As trusts work to cut the waiting times following the COVID-19 pandemic, there is an evident need for more efficient practices. The use of validated, safe triaging methods such as this can play a central role.

Thyroid storm is an acute life-threatening condition of hyperthyroidism that can present with cardiac failure, requiring extracorporeal membrane oxygenation (ECMO). We present the first case reported of total thyroidectomy successfully performed while on ECMO for thyroid storm in a 32-year-old male. This case highlights the challenges of managing refractory thyroid storm with multi-organ failure. We demonstrate that total thyroidectomy may still be safely performed while on ECMO for thyroid storm, if steps are taken to optimise the patient perioperatively, with careful surgical and anaesthesia planning.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04430-9.

A 14-year-old girl suffered a rare injury when a pen pierced her left eye, leading to a foreign object lodged in her ethmoid sinus. Prompt diagnosis and endoscopic sinus surgery (ESS) effectively removed the object, highlighting ESS as a valuable approach for managing uncommon sinus foreign bodies while minimizing complications.

Oral cancers comprise 50% of all head and neck malignancies in India which can be attributed to tobacco chewing. Advanced oral cancers are managed with surgery followed by adjuvant radiotherapy or adjuvant chemoradiation. There is paucity of studies regarding need for adjuvant treatment in oral cancers with close margins i.e. ≤ 0.5 cm after formalin fixation. This study aims at documenting the oncological outcome with regards to loco-regional control, disease-free survival, overall survival and complications of adjuvant radiotherapy and adjuvant chemoradiation in operated oral cancer patients having close margins of resection. In this Retrospective cohort study, 163 patients with stage T1-T4 oral cancers operated between 2015 and 2019 who have fulfilled the inclusion and exclusion criteria, received adjuvant treatment and could be followed up for at least one year were included. At the end of 45 months, the overall survival was 74.7% and disease specific survival was 82.7%. Among the 7 patients who defaulted radiotherapy, 4 patients succumbed to the disease. Complications were bone marrow depression (2 patients), dysphagia (17) and Trismus (1). Adjuvant radiotherapy should be given in oral cancer patients with close margins of resection since it improves the oncological outcome and disease specific survival and the benefit often outweighs the risk.

Among the various anatomical landmarks during neck dissection, digastric muscle is one of the most important. It is well known that all important blood vessels in neck lies deep to digastric. Thus, it acts as a safety landmark during neck dissection. In this article we describe a variation in vascular anatomy with relation to posterior belly of digastric that has not been reported so far during live surgery. Surgeon performing neck dissection should have a detailed knowledge of anatomy and infrequent anatomical variation. The knowledge of current anatomical variation will avoid torrential bleed during neck dissection and preserve the artery for vascular related procedures.

Since the COVID-19 pandemic, masks have become far more widely used by doctors and are now commonplace in the hospital, with many professionals still wearing them for extended amounts of time. Emerging literature describing numerous mask-related difficulties prompted the authors to conduct a study aimed at assessing the self-perceived impact on voices of teaching doctors due to facial protective gear. In this study carried out from October 2021 to March 2022, data was gathered from 170 pre-, para-, and clinical professionals who were involved in offline teaching. Over half of teaching medical professionals were found to be vocally fatigued. Pre and para-clinical professionals have greater vocal tiredness and avoidance than clinical doctors (p = 0.016). The type of mask used does not make a significant difference in degree of vocal fatigue. Individuals with lingering respiratory difficulties following COVID-19 were significantly more vocally fatigued than their recovered peers (p value for tiredness and avoidance = 0.010). Thus, teaching doctors are at risk of impaired quality of life due to vocal fatigue. Further research on vocal habits and rest practices in the study population may help identify the most effective interventions.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04350-8.

There are discrepancies in the literature about the specific influence of leprosy on auditory functions. In routine clinical practice regular hearing screening of leprosy patients is not done. Due to conflicting reports of auditory system involvement in the literature, we conducted this case control study to evaluate the need of regular hearing screening in leprosy patients. A complete otological examination of thirty leprosy patients was conducted. Thirty age and sex matched healthy individual attending ear, nose and throat outpatient department were enrolled as control. Ten cases (33.3%) out of the thirty leprosy patients were found to have high frequency (4 and 8 kHZ) sensorineural hearing loss. The results of this study suggest that leprosy patients require routine monitoring for auditory functions for early identifications of sensorineural hearing loss. As our study is a case-control study with small sample size, in future large prospective studies are required to evaluate the correlation of hearing loss with leprosy and to see the progression hearing loss.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04381-1.

Introduction: The imaging of the paranasal sinuses has advanced from plain X-ray films to CT and MRI. This advancement in the radiological field helps to yield more accurate information and aids in arriving at a proper differential diagnosis, especially for rhinosinusitis. However, CT should be used cautiously among patients considering its effects due to radiation. Aim: This study aims to correlate the pre-operative radiological findings with the intraoperative functional endoscopic sinus surgery findings in a series of 100 cases. Materials and Methods: A retrospective case series was conducted among 100 cases who had complaints relating to nose and paranasal sinuses in a tertiary care hospital, Chengalpattu. Their symptoms, clinical examination, pre-operative radiological findings, and intra operative findings have been recorded. The collected data was analyzed for correlation and agreement between pre-operative radiological findings and intraoperative findings. Results: Almost all the CT revealed pathologies like polyps, mucosal thickening, and anatomical variations. However, intraoperatively, only 64.5% had mucosal thickening and 23.6% had polyps. Poor to acceptable correlation has been reported among patients with OMC obstruction, polyps, and mucosal thickening, respectively. Yet, no agreement was seen between pre-operative radiological and intraoperative findings. Conclusion: Endoscopy remains the most valuable test to diagnose, confirm the severity and manage sinus related diseases.

Auditory Neuropathy (AN) poses a substantial challenge in neonatal auditory screenings due to its complex course and potential for delayed onset. Early identification and intervention are important for optimizing developmental outcomes. This study aimed to explore the prevalence, determinants, and temporal progression of AN in neonates, and assess the therapeutic benefit of amplification devices on their communication skills. The study utilized a longitudinal cohort design to analyze a cohort of 200 neonates from a tertiary care center over the duration from January 2021 to December 2022. Auditory evaluations were conducted at specified intervals, utilizing a comprehensive battery of auditory assessments. Statistical analyses, including regression models, were employed to identify associations between various determinants and the progression of AN. The results of the study revealed a significant correlation between low birth weight and familial history with onset of AN. The data also revealed a gradual rise in AN prevalence over the study duration. However, a negative correlation was observed between AN severity and communication skills. The utilization of hearing aids was associated with enhanced communication outcomes. The study highlights the importance of comprehensive auditory screenings in newborns, particularly emphasizing the early detection and intervention of AN. Based on empirical findings, it emerged that amplification devices, particularly hearing aids, have the potential to mitigate the detrimental effects of auditory neuropathy (AN) on communication skills. This study provides a valuable contribution to the academic debate by highlighting the need for strengthening neonatal auditory screening protocols. The findings have profound implications for clinical practices, highlighting the role of early interventions in optimizing developmental prospects for neonates diagnosed with AN.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04386-w.