Frequency-Specific Audit of Audiological Outcomes Following Stapedotomy for Otosclerosis.

Stapedotomy is an effective surgical intervention used for the treatment of conductive hearing loss associated with otosclerosis. The present study aims to quantitatively evaluate the hearing outcomes following primary stapedotomy performed in patients with otosclerosis. It also aims to investigate frequency-specific hearing results of stapedotomy in these patients. This retrospective study enrolled 49 patients with clinical otosclerosis, who underwent primary stapedotomy at a tertiary-care hospital, between January 2014 and December 2019. Pure-tone audiometry (PTA) was performed pre and post-operatively (> 1 year after surgery). Post-operative air conduction (AC) and bone conduction (BC) thresholds were recorded. The primary outcome measure was post-operative air-bone gap (ABG). Low frequency (LF) ABG was calculated as the mean ABG of thresholds at 0.5 and 1 kHz. High frequency (HF) ABG was calculated as the mean ABG of thresholds recorded at 2 and 4 kHz. In all the study patients, the mean post-operative AC and the mean postoperative BC thresholds, showed significant improvement across the tested frequencies of 0.5, 1, 2 and 4 kHz (P < 0.05). The mean post-operative ABG closure was superior at HF, as compared to that at LF (9.54 ± 6.30 dB vs. 12.0 ± 6.63 dB, P = 0.014). A successful surgical outcome (post-operative ABG closure to ≤ 10 dB) was achieved in 61.22% of the study patients. Further, a greater number of patients (71.45%) recorded successful surgical outcome at HF, when compared with those at LF (46.95%, P < 0.05). Favourable hearing outcomes of this study underscore the effectiveness of primary stapedotomy in the treatment of patients with clinical otosclerosis. Better postoperative ABG closure to ≤ 10 dB was recorded at higher frequencies. Further studies assessing post-stapedotomy hearing results at HF are warranted for ensuring better hearing outcomes in the HF range as well. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04126-0.

A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center.

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021-June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

Cochlear Implant Surgery During the Covid Pandemic Lockdown-The KEM Hospital, Pune Experience.

In response to the Covid 19 pandemic many governments and professional bodies recommended cancellation of elective surgeries including cochlear implantation. Resumption of elective surgeries was recommended after appropriate permissions were given by the authorities and the hospital had adequate infrastructure in terms of equipment and manpower to start elective surgeries without compromising on patient safety and care. We began cochlear implant surgeries in April 2020. We have done 5 cochlear implants surgeries till date. This manuscript discusses the changes that we did in our preoperative, intraoperative and postoperative protocol.

Surgical complications and their management in cochlear implantees less than 5 years of age: The KEMH Pune experience.

OBJECTIVE: To evaluate the incidence of surgical complications of cochlear implantation and their management at K.E.M. hospital Pune. METHODS: It was a retrospective and prospective observational study conducted from February 2006 to December 2015 in the paediatric age group of 12 months to 5 years (213 cases). The complications were divided into major and minor groups based on the classification proposed by Cohen and Hoffman. RESULTS: The mean age of implantation was 3.03 years (ranged from 1 to 4.11 years). Sixteen patients had complications. The overall incidence of complications was 7.51% which comprised of major (2.34%) and minor (5.16%) complications. The commonest major complications were flap-related issues and the commonest minor complication was facial paresis. DISCUSSION: The results of our study were compared with similar studies conducted in the past. All surgical complications were treated conservatively or surgically with success. CONCLUSIONS: Cochlear implantation is the safe procedure in children between the age group of 12 months and less than 5 years.

Bilateral cochlear implantation under local anaesthesia in a young adult - A case report.

OBJECTIVE: Cochlear implantation is routinely performed under general anaesthesia in most centres in the world. There have been reports of this surgery being performed under local anaesthesia and sedation for unilateral cochlear implantation. Our case study reports the first bilateral cochlear implantation carried out under local anaesthesia with sedation. This paper outlines the protocol used and discusses the challenges and advantages of the procedure being performed under local anaesthesia. CASE STUDY: A 28-year-old female with a history of multidrug-resistant tuberculosis presented with bilateral severe to profound sensorineural hearing loss. On evaluation, she was found to be a suitable candidate for cochlear implantation. However, she was clinically unfit to undergo the surgery under general anaesthesia. After counselling the patient, the decision to undertake the procedure under local anaesthesia was made. The procedure took 105 min and was uneventful. The patient was discharged the next day Conclusion: In the hands of an experienced surgeon and anaesthesiology team, bilateral cochlear implantation is possible under local anaesthesia. Patient motivation and cooperation are extremely important for the procedure to be done under local anaesthesia. This is an option for patients needing cochlear implantation who are medically unfit for general anaesthesia.

A multicentric, open label, randomised, postmarketing efficacy study comparing multidose of lincomycin hydrochloride capsule 500 mg with multidose cefpodoxime proxetil tablet 200 mg in patients with tonsillitis, sinusitis.

Tonsillitis causes considerable short and medium term morbidity, and can be recurrent. Sinusitis can be acute (less than 4 weeks), subacute (4-8 weeks) or chronic (8 weeks or more). To study the comparative efficacy and safety of multidose treatments of lincomycin hydrochloride 500 mg capsules against cefpodoxime proxetil 200 mg tablets on its outcome in the Indian scenario are the aims and objective of the study. A total of 41 tonsillitis, sinusitis cases of either gender aged above 18 years were enrolled in the study. The diagnosis of sonsillitis, sinusitis was made based on examination of symptoms and throat swab. A randomised treatment of either lincomycin hydrochloride 500 mg capsules or cefpodoxime proxetil 200 mg tablets twice daily for five days alongwith other concomitant medications depending on related symptoms was given to 40 patients. At the end of study, all patients were re-evaluated and the response rate was assessed. The most common clinical symptoms were body temperature, headache, throat pain, postnasal discharge, mucopus, odynophagia, sinus tenderness, nasal congestion, pharyngeal congestion and tonsillar congestion. The overall response rate of lincomycin hydrochloride in all the symptoms except headache was more effective than cefpodoxime proxetil. Out of 100% (n = 20) patients in each group, 67.89% in lincomycin and 52.27% in cefpodoxime patients achieved complete relief, in all the clinical symptoms. The study suggests that lincomycin hydrochloride capsules, a conventional antibiotic indicates effective treatment for relief from tonsillitis and sinusitis, as compared to new third generation antibiotic.

Tooth in a cyst - Is it always a dentigerous cyst?

We present the case report of an 18-year-old female patient who presented with unilateral nasal obstruction. Computed tomography scanning revealed an unerupted molar in the posterior wall of the right maxillary sinus with a cystic swelling in the sinus. The preoperative diagnosis was a dentigerous cyst. The patient underwent endoscopic removal of the cyst and tooth. The operative findings and histopathology showed that it was an odontogenic keratocyst. This paper stresses the importance of diagnosing this condition and that a tooth in a cyst is not always dentigerous.

Necrotising fasciitis of the neck.

Necrotising fasciitis is a fulminant soft tissue infection that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle initially. It is most commonly seen in adults involving the perineum, extremities and and minal wall. Immunncompromised patients are at an increased risk of developing this infection. These infections require early diagnosis, aggressive surgical debridaient and appropriate antibiotic therapy. Mortality rates have been reported to be as high as 52 and 73% in general surgery literature.(Freuschtag et al, 1985., Rouse et at 1982).Necrotising fasciitis of the head and neck is rare. The commonest cause is secondary to denial infections. We report a case of necrotising fasciitis of the neck secondary to a peritonsillar abscess in a previously healthy individual. The pathogenesis and treatment of this fulminant infection are also discussed.