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

The purpose of this study is to describe challenges in diagnosis and treatment of otologic fungal infections.; 2) Methods: Case series and literature review 3) Results: Three patients treated at Louisiana State University Health Sciences Center - Shreveport between November 2020 - November 2023 were identified with complicated fungal otitis externa requiring detailed radiologic and histopathologic workup to aid in diagnosis and management. 4) Conclusion: Diagnosis of otologic fungal infection is often complex due to similar presentation of more common pathogens, overlapping features among common fungal specimens, and limitations of available diagnostic methods. Patient factors, including diabetes with poor glycemic control, may further complicate this challenging disease. High index of clinical suspicion, collaboration between multidisciplinary teams is essential to differentiate between common and uncommon fungal ear infections. A combination of mechanical debridement, topical and/or systemic therapy, and longitudinal follow-up with otolaryngology and infectious disease teams is required for successful treatment.

Ceruminous adenoma is a rare and benign tumor of the external auditory canal and present with a nonspecific symptom. Biopsy with histopathology examination is required to establish the diagnosis. Wide local excision of tumour shows favourable outcome with a low recurrence rate. Here, we present a case of ceruminous adenoma masquerading as a furunculosis.

Aim: To identify and know the antimicrobial sensitivities of the aerobic bacteria in patients with acute otitis externa (AOE).

Materials and methods: Sixty-six patients of acute otitis externa were prospectively analysed at a tertiary care centre in North-India from May 2021 to April 2022. Samples for culture and sensitivity were sent to the microbiology department and the results analysed.

Results: A total of 50 samples yielded positive results for bacterial cultures. The gram-negative isolates were 60%, and the gram-positive were 40%. Pseudomonas aeruginosa was the most common organism isolated overall (48%), followed by Staphylococcus aureus (36%). Pseudomonas aeruginosa isolates were found to be most susceptible to piperacillin + tazobactam and imipenem (100%), followed by cefepime (91.67%) and ciprofloxacin (87.5%) while the Staphylococcus aureus isolates were found to be most susceptible to linezolid (100%) and doxycycline (94.44%), followed by clindamycin (88.89%).

Conclusion: Causes of bacterial diversity and their varied anti-microbial sensitivities and increasing antimicrobial resistance due to inadvertent use of antibiotics over time has caused change in susceptibility of bacteria. It therefore becomes essential to periodically assess the microbiological flora so as to provide quality and cost-effective treatment to the patient population presenting with AOE.

The main aim of the current study was to identify and analyze the most significant clinical and sociodemographic predictors of parents' perceptions regarding their child's stuttering. 139 parents, with at least one child who stutters, completed both the Persian version of the Palin Parent Rating Scale (P-Palin PRS) and a sociodemographic and clinical checklist. To investigate the relationships between scores on the Palin PRS factors and sociodemographic and clinical characteristics, we conducted univariable analyses using Pearson correlation coefficients, independent t-tests, and one-way ANOVA. The study analyzed the P-Palin PRS factors: Impact of Stuttering on the Child, Severity of Stuttering and Impact on the Parents, and Parent's Knowledge and Confidence in Managing it. Mean scores were 5.37, 3.87, and 5.42, respectively, with correlations ranging from 0.371 to 0.507. Higher stutter severity negatively correlated with Impact on the Child (r=-0.364, P < 0.001). History of speech therapy (ST) failure and family history of speech and language disorders (SLDs) showed lower Impact scores (P = 0.053 and P = 0.057). Severity of Stuttering and Impact on the Parents negatively correlated with stutter severity (r=-0.546, P < 0.001) and positively with parents' ages. Parent's Knowledge and Confidence correlated negatively with stutter severity (r=-0.242, P = 0.004) and was lower in those with family history of SLDs (P = 0.008). The high stutter severity, ST failure, and family history of SLDs were associated with lower scores across all PRS factors. In conclusion current study identified key predictors influencing parents' perceptions of their child's stuttering, including stutter severity, speech therapy history, and family background.

The acoustics of cervical auscultation of swallowing, a potential objective tool for the swallowing assessment, has been explored in normal subjects. However, there needs to be more literature profiling the same in individuals with swallowing problems. The study estimated the acoustic features of swallowing sounds in individuals with swallowing and voice problems and compared them with the previous reported findings in literature. Eight individuals with dysphonia and dysphagia were recruited to analyse cervical auscultation using a vibration pickup conduction microphone attached to the cricoid region on the neck of each participant. The participants showed different acoustic wave morphologies for swallowing sounds, including multiple waves, which were absent in the normal waveforms. The mean intensity, peak intensity were as higher in the current study participants than normal values reported literature in previous, suggesting increased strain and effort in individuals with dysphagia. The duration parameters were comparatively longer than those reported in previous literature showing the prolonged pharyngeal stage. The morphological and acoustic characteristics of swallow sounds in dysphagic and dysphonic individuals are deviating from then normal patterns. The utilisation of these features will help comprehensive diagnosis of swallowing difficulties. The LTAS was found to be the appropriate way of estimating the frequency of the peak intensity than using the intensity contour in the spectrogram since the values calculated using LTAS are more representative of the parameters. The study was a preliminary attempt to explore the acoustic features in individuals with voice and swallowing problems.

Introduction: Tonsillectomy is commonly associated with significant postoperative challenges such as pain management, complication monitoring, and patient recovery. Traditional care methods, while effective, often do not adequately address these issues, particularly in personalized care and remote monitoring. This study assesses the impact of Artificial Intelligence (AI)-assisted postoperative care on recovery outcomes in tonsillectomy patients compared to conventional care methods. Methods: Conducted at a tertiary care hospital's Otolaryngology Department from January to December 2023, this observational cohort study involved 100 elective tonsillectomy patients. Participants were divided into two cohorts: one receiving traditional care and the other AI-assisted care, which utilized machine learning for pain management, continuous symptom monitoring through wearable devices, and virtual assistance. Results: AI-assisted care significantly improved early postoperative pain management, reducing pain scores to 5.2 ± 1.1 from 6.5 ± 1.2 in traditional care (p = 0.01). Dehydration rates decreased from 6 to 1% (p = 0.05), and the average hospital stay was reduced to 2.8 ± 1.1 days from 3.5 ± 1.2 days. While no significant differences were found in readmission rates for haemorrhage and infection, patient satisfaction notably increased, with pain management improving to 4.4 ± 0.7 and overall satisfaction to 4.1 ± 0.6 (p = 0.03). Conclusion: AI-assisted care offers significant advantages over traditional methods in managing tonsillectomy recovery, optimizing surgical outcomes, and enhancing patient satisfaction. This study supports further exploration into AI's long-term outcomes and its application across various surgical fields.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-05103-x.

Background: Adenoid hypertrophy alters the posture of the oro-facial structures by obstructing the upper airways and restricting nasal breathing. These postural changes may eventually have an impact on facial skeletal development and dental occlusion. The postural adjustments may negatively impact a child's life by affecting a number of speech-production factors.

Objective: This study aimed to detect the speech sound disorders in school aged Egyptian children with adenoid hypertrophy and if they were related to structure changes in the airway that caused by adenoid hypertrophy.

Methodology: 300 school-aged Egyptian children aged from (5-15) years old with speech sound disorders (SSD). They were divided into 2 groups; Group 1 consisted of 150 children with speech (SSD) and adenoid hypertrophy, and Group 2 consisted of 150 children complained from (SSD) without adenoid hypertrophy. All children were evaluated by protocol of language assessment and articulation test used in Assiut University Hospital.

Results: Speech sound disorders (SSD) mainly the omission and distortion are more frequent in (group 2) while, the substitution errors are more prominent in (group 1). The interdental sigmatism was the most frequent speech sound disorder in (group 1) especially those with adenoid hypertrophy occupying more than 50% of the airway, whereas, devoicing, gliding and back to front are more frequent in (group 2).

Conclusion: Adenoid hypertrophy can affects only the /s/ sound production which needs precise placements of the articulators especially the tongue, and seems to be vulnerable due to the structural alteration of the oral cavity caused by adenoid hypertrophy.

To determine salivary pH in patients with Laryngopharyngeal Reflux (LPR) and compare it with that of normal individuals. A cross sectional analytical study was done. Adults with LPR as determined by Reflux Symptom Index (RSI) > 13 and Reflux Finding Score (RFS) > 7 were included in LPR group. Normal healthy adult participants with Reflux Symptom Index ≤ 3 and Reflux Finding Score ≤ 2 were included in non LPR group.32 participants were included in each groups. Salivary pH was determined in all participants using a standardized pH meter. Difference in salivary pH between two groups was statistically analyzed. The mean salivary pH in LPR group was 7.43 ± 0.77 and in non LPR group 7.0 ± 0.77. There was a statistically significant difference between the mean salivary pH between the two groups as determined by p value 0.004. The results of our exploratory study showed statistically significant difference in salivary pH between LPR and non LPR group. The salivary pH in 10(31.2%) out of 32 participants in LPR group was beyond the normal range and surprisingly the value was > 7.6, which was in contrast to acidic pH that was expected as per hypothesis. The rest 68.8% in LPR group had pH in the normal range. However salivary pH as a modality for diagnosing LPR cannot be concluded from such preliminary study with a small study population. This study forms a basis for future research for the role of salivary pH in LPR with better study designs and finer modalities of pH testing.

Cochlear implants (CIs) are a well-established treatment for severe to profound hearing loss, particularly in young children. The success of CIs is influenced by various factors, including the age of implantation and the quality and duration of post-operative rehabilitation, such as Auditory Verbal Therapy (AVT). AVT plays a crucial role in developing listening and spoken language skills in children with CIs. However, the impact of AVT duration on long-term outcomes remains unclear. This study aimed to investigate the impact of AVT duration on the long-term auditory and speech outcomes of children who received CIs between 9 and 12 months of age. Specifically, we compared the outcomes of children who received AVT for one year, one and a half years, and two years after implantation. This descriptive cohort study included 45 children diagnosed with severe to profound hearing loss who received unilateral CIs and completed at least one year of AVT. Participants were divided into three groups based on AVT duration (Group A: 1 year, Group B: 1.5 years, Group C: 2 years). Their auditory perception, speech intelligibility, receptive and expressive language, and speech production skills were assessed using standardized tests five years post-implantation.. Children who received AVT for two years (Group C) demonstrated significantly better outcomes in auditory perception and speech intelligibility compared to those who received AVT for one year (Group A). Group C also exhibited higher scores in expressive language and speech production, while both groups achieved similar results in receptive language. These findings suggest a positive correlation between AVT duration and long-term language and speech development. Early cochlear implantation, coupled with continuous AVT for at least two years, significantly enhances auditory and speech abilities in children with severe to profound hearing loss. This study underscores the importance of extended AVT duration to maximize the long-term benefits of cochlear implants and enable children to reach their full communication potential.

CSF rhinorrhea secondary to anterior skull base defect may be spontaneous or traumatic (accidental or iatrogenic), spontaneous being common in middle aged, obese females. Nowadays endoscopic technique is gold standard for anterior skull base defect repair. The graft materials available may be autologous (fat, temporalis fascia, fascia lata, septal mucosa, cartilage, middle turbinate), homologous e.g., cadaveric pericardium or allograft e.g. dural substitute. Leukocyte-platelet rich fibrin (L-PRF) is a newer graft material that contain concentrated platelets and doesn't require any exogenous material or chemical in blood. A prospective study including 31 patients was carried out at tertiary care centre in eastern India, over the period of 2 years. All the surgeries targeted for closure of the anterior skull base defect were performed endoscopically under general anaesthesia. 30 out of 31 (96.77%) patients successfully improved after repair and one patient required revision surgery due to recurrence of disease and was cured after revision surgery. Autologous Leokocyte-plasma rich fibrin (L-PRF) is a newer and cost-effective graft material for the CSF leak repair with good healing property and with a success rate of more than 95%.