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

Prosody is an essential component of speech naturalness and improves speech intelligibility. Prosodic deficits are notably prevalent among children with hearing impairment (CwHI). Speech Language Pathologists (SLPs) are service providers responsible for identification and intervention of disorders of prosody. So far, there are limited published reports on the awareness and competence of SLPs in prosody intervention. The present study aimed to understand the knowledge and perspectives on prosody of SLPs working among CwHI through an online survey. A 10-item questionnaire was developed and utilized for this purpose. Additionally, information on the clinical service delivery of the respondents was also collected. A total of 130 SLPs responded to the survey (response rate = 65%). Although most respondents (93.1%) agreed that prosodic impairment impacted speech intelligibility of CwHI, 76.2% never provided intervention for prosodic deficits in CwHI. Several respondents (74.6%) opined of not receiving adequate training on assessment and intervention of prosodic impairments in CwHI. 82.3% of respondents were unaware of prosody assessment or treatment materials for CwHI. More than half of respondents (56.9%) felt that prosody is usually a low priority when considering the speech and language needs for CwHI. Nevertheless, 73% of respondents believed that it is necessary to target prosody as early as possible along with conventional speech and language interventions. The findings from this survey identify a clinical area largely ignored by SLPs among CwHI. Addressing these could lead to more comprehensive clinical care for CwHI, ultimately improving speech intelligibility and communication outcomes.

Ossicular defects due to chronic ear disease are common and continuous problem for otologic surgeon. Ossicular reconstruction prostheses are widely used to restore ossicular continuity when the incus is eroded or missing, for example, in chronic otitis media or cholesteatoma. In this regard; the total and partial ossicular replacement prosthesis (TORP and PORP) have been enthusiastically endorsed. Traditionally, either PORP or TORP is applicable, depending primarily on whether there is an intact stapes superstructure or only a stapes footplate. Laser interferometer studies on the mechanics of the reconstructed human middle ear have shown that, from a mechanical viewpoint, the malleus to footplate type of reconstruction gives a more favourable result compared with a malleus to stapes superstructure reconstruction even in presence of intact stapes suprastructure. However, it is still unclear whether ossicular reconstruction has a better long-term outcome with PORP or TORP in the presence of stapes suprastructure. A prospective randomised trial of 60 patients with Austin type A defects divided into two groups was conducted. In one group TORP was used and in other group PORP. Outcomes were studied in terms of hearing gain, AB gap closure and stability of the prosthesis. Preoperative PTA of Moderate Conductive Hearing loss (40-55 db) was most found followed by severe conductive hearing loss (> 55 db) with standard deviation of 7.155 and mean hearing loss was 46.30 db in TORP group. In this group post operative pure tone averages improved to mild hearing loss (26-30 db) in about 90 percent of patients with mean of 32 db and standard deviation of 7.06. Preoperative PTA of severe Conductive Hearing loss (> 55 db) was most found followed by moderate Conductive Hearing loss (45-55 db) with standard deviation of 6.471 and mean hearing loss was 47 db in PORP group. Post operative Pure Tone averages improved to Mild Hearing loss (26-30 db) in about 90 percent of patients with mean of 33 db and standard deviation of 5.431 in PORP group. ABG reduction in TORP group was 22.603 ± 12.34 while in PORP group was17.79 ± 10.743. Hearing gain and ABG closure is almost comparable with both TORP and PORP, however because of increased stability of TORP we recommend TORP for better long-term outcomes in Austin type A ossicular defects.

Cartilage perichondrium composite grafts (CPCG) have been used in tympanoplasty for many years. Reperforations can be seen because of various problems. The aim of our study is to describe a graft technique to minimise the complications and to evaluate the success of the graft. The ears which underwent type 1 tympanoplasty using CPCG were included in the study. Over-underlay graft technique was used in all operations. They were performed by microscopic transcanal approach and by the same surgeon. Fifty-four ear operations of 48 patients were included in the study. While the preoperative average pure tone- average (PTA) of the ears was 45 (21-75) dB, the postoperative average PTA was 28 (11-58) dB. While the preoperative air bone gap (ABG) of the ears was 23.3 (10-43.3) dB, the postoperative ABG was 11.6 (0-28.3) dB. A significant improvement was achieved in both ABG and PTA values after the operation (p < 0.001). The graft success rate was 94.4%. The cartilage graft modifications such as block cartilage, palisade, cartilage island and butterfly have been applied successfully. We aimed to reduce the risk of reperforation, maximise audiological gain and facilitate the follow-up of postoperative middle ear pathologies by thinning the cartilage island and extending the perichondrium to the external auditory canal in the modification of CPCG. The graft success rate and the audiological success rate are high enough to be compared with the literature. The described CPCG can be used safely in all types of perforations, especially in high-risk perforations.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-04965-5.

Objective: The study aimed to examine postural stability changes in individuals who have recovered from COVID-19 infection.

Methods: Fifty patients who recovered from the COVID-19 infection and 50 healthy controls were compared using the dizziness handicap inventory (DHI), a modified clinical test of sensory interaction balance (mCTSIB), limits of stability (LOS), rhythmic weight shift (RWS), and Romberg and fall risk (FR) tests.

Results: Regarding mCTSIB, regardless of gender patients, female patients, or male patients, there were no significant differences from controls (p > 0.05). There was a significant difference in LOS between the patients and controls regarding (p < 0.05) in some parameters. There was a significant difference between the patients and controls concerning RWS (p < 0.05) for some parameters. There was a significant difference between the patients and controls regarding the Romberg test in some parameters (p < 0.05). There was no statistically significant difference between the patients and control groups regarding FR.

Conclusion: Studies in which the effects of COVID-19 infection sequels have been evaluated on the vestibular system in the literature are subjective. The main concern is the prevalence of dizziness or vertigo in subjective studies. There may be a decrease in postural reflexes in female individuals who recovered from the COVID-19 infection in this study, thanks to the objective test measurement. Increased oscillations with eyes closed on regular ground and soft ground in the Romberg test may likely indicate vestibular problems.

The study aimed to assess the risk of hearing loss in full-term neonates with hyperbilirubinemia, examining the relationship between bilirubin levels, onset age of hyperbilirubinemia, and hearing impairment. Additionally, it investigated whether hearing loss was transient or late-onset, using a cost-effective double-screening method. The study included 160 full-term neonates aged 0-1 month. Following completion of phototherapy for hyperbilirubinemia, all infants underwent initial screening with otoacoustic emissions (OAEs) and automated auditory brainstem responses (AABR). A second screening was administered to all infants within one month. Infants referred during the second screening, regardless of their first screening results, underwent diagnostic evaluation. For analysis, the infants were categorised into 4 groups, based on their bilirubin levels and onset of jaundice. After the initial screening, 37% of infants were referred, which decreased to 9% after subsequent screening, suggesting transient hearing loss in 76% of initially referred infants. Permanent hearing impairment was confirmed in 2.5% of infants following diagnostic evaluation, with 3 infants diagnosed with ANSD and 1 infant with sensorineural hearing loss, all from categories characterized by elevated bilirubin levels. The findings indicated that even bilirubin levels as low as 12 to 15 mg/dl could lead to hearing loss, particularly when jaundice onset occurred early. This study highlights the effectiveness of double-screening for identifying transient hearing losses in infants with hyperbilirubinemia, minimizing the need for diagnostic referrals. It underscores the importance of considering both bilirubin levels and onset timing to assess auditory risk fully.

Metastasis of Lymph nodes are the independent prognostic factors in squamous cell carcinoma of head and neck. Hence, meticulous dissection of neck makes an important and vital procedure to help improve prognosis and overall survival rate. The ultimate goal of neck dissection is to remove all the lymph nodes from level I to IV while preserving important anatomic structures that comes across. Clear surgical field helps identify these important structures and preserve them. We have come up with a new term for complex of small vessels which are constant at the deep lobe of submandibular gland, Hatti's plexus which helps in avoiding accidental damage to lingual nerve and provides good surgical field.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-05049-0.

Eustachian tube is complex and inaccessible structure. It connects nasopharynx to middle ear. It is composed of cartilaginous and bony segments. Eustachian tube helps in pressure regulation, protection and clearance of the middle ear. Dysfunctions of Eustachian tube are either due to anatomical obstruction or functional failure. Whether variation of length, width of bony canal, isthmus, length of the cartilaginous canal and angulation of the Eustachian tube to horizontal plane affects overall pressure regulation, protection and mucociliary clearance leads to the spread of the infection to the middle ear are highlighted. A comparative prospective study design of 20 adults of both gender of normal ear computerized tomography done for some other cause and 20 adults of both gender with chronic otitis media (tubo-tympanic pathology). After obtaining consent, clinical examination, all patients had got computerized tomography study of the temporal bone and were evaluated to study the variation of length, width of bony canal, isthmus, length of the cartilaginous canal and angulation of the Eustachian tube to horizontal plane. In our series cartilaginous Eustachian tube length is 26.72 mm in normal ear and 26.17 mm in diseased ear. Long and reduced diameter of bony segment is the anatomical cause in the tubotympanic pathology along with inflammation and loss of ciliary moment. Normal ear bony width is 2.36 mm; isthmus 1.18 mm are comparatively more than diseased ear (bony width 2.13 & isthumus1.04). Whereas bony length of normal ear is 11.21 mm and diseased ear is 11.62 mm. Decreased Eustachian tube pretympanic diameter and Reid -plane ET angle can be used to predict Eustachian tube dysfunction. Angle to horizontal plane in our series in normal ear 44.670 whereas in diseased ear 45.10. The Eustachian tube plays an important role in the development of the tubotympanic pathology of the ear. Pre-existing Eustachian tube anatomical variation appears to be risk factor in developing tubotympanic pathology.

A 17 year old male patient presented with bilateral preauricular sinus, right sided second branchial cleft sinus and bilateral hearing deficit. He has previous history of right congenital cataract surgery and right dacryocystorhinostomy at the age of 8 year. He was operated for branchial sinus. No family history with similar complaint was observed. According to all these features this case was the variant of branchio-oto-renal spectrum disorder with de novo mutation. According to literature search this will be a unique and rare case report of BORSD published till date in India.

High-output Chyle leak is a dreadful complication following neck dissection, posing challenges in management due to the morbidity associated with prolonged leakage. This case series describes the efficacy of a novel Indocyanine Green (ICG) Fluorescence-guided Robotic Transthoracic thoracic duct ligation technique in intractable high-output chyle leaks following neck dissection. Three patients with persistent high-output chyle leaks following neck dissection underwent robot-assisted thoracic duct ligation. Preoperative evaluation, surgical technique, postoperative care, outcomes and follow-up were recorded. All patients experienced successful resolution of chyle leaks with no intraoperative complications. Postoperative recovery was uneventful, and no recurrences were observed during the follow-up period. ICG-guided robotic transthoracic thoracic duct ligation is a safe and effective method for managing persistent high-output chyle leaks following neck dissection, offering a minimally invasive technique with favourable outcomes.

We report an uncommon odontogenic actinomycotic cervicothoracic Nectrotizing Fasciitis (NF), treated with tracheostomy, immediate surgical debridement and antibiotics. Red flags for early identification, LRINEC scoring for prognostication, surgical debridement with aerobic & anaerobic culture specific antibiotics to improve survival in this life-threatening cervicothoracic NF in a young diabetic is discussed.