Observational study on the clinical profile and treatment outcome on long-term follow-up of COVID-19 associated mucormycosis.

MATERIALS AND METHODS: Patients diagnosed with COVID-19 associated mucormycosis were followed up for 6 months to study the clinical profile, readmissions, long-term treatment outcome and the mortality rate. RESULTS: Among 37 patients with COVID-19 associated mucormycosis, the mortality rate was 33.3 %, 42.9% and 100 % among patients with mild, moderate and severe COVID-19 infection. One month after discharge, among the 20 patients who survived, 10 (50 %) patients had worsening symptoms and required readmission. Nine patients required readmission for amphotericin and 1 patient was admitted for surgical intervention. On follow-up at 1 month, 30 % (6/20) patients became asymptomatic. However, at 3 months, 45 % (9/20) of the patients were asymptomatic. At 6 months of follow-up, 80 % (16/20) were asymptomatic. At 6 months, one each had residual abnormalities like visual loss in one eye, visual field deficit, change in voice and residual weakness of the limbs along with cranial nerve paresis. CONCLUSION: The follow-up study revealed that a significant number of patients required readmission within the first month, but most of the patients became asymptomatic by 6 months. The readmission rate was higher in patients who received a shorter duration of amphotericin.

Utility of Smart Phones as a Voice Acquisition Device for Assessing Pre and Post Treatment Voice Using PRAAT.

Voice assessment before and after treatment helps the clinician to assess the effectiveness of the treatment given and facilitates comparison between different treatment modalities. Voice handicap index -10(VHI-10) questionnaire is a tool which allows the voice to be evaluated subjectively from the patient's perspective. PRAAT is a freely available, software programme that acoustically analyse voice signals. Smart phones are widely used and the high quality of the embedded microphone in it makes it a suitable and easily available voice recording device. This study aims at using PRAAT and VHI-10 questionnaire in evaluating voice before and after treatment. The utility of smart phones as a voice acquisition device is also explored in the study. Prospective, observational study, carried out from 1st November 2019 to 30th September 2021in the ENT out- patient department at a tertiary hospital in Punjab. 58 patients complaining of dysphonia were enrolled consecutively in the study. All patients underwent detailed history, examination of the larynx using 70-degree rigid laryngoscope. The voice handicap was scored by (VHI-10) questionnaire and acoustic evaluation of voice was done using the PRAAT software. Patients' voice was further evaluated 3 months post-therapy with VHI 10 questionnaire and acoustic analysis. The parameters measured on PRAAT were mean pitch, jitter (local), shimmer (local), and mean harmonics to noise ratio (HNR). The voice was recorded using a smart phone and later transferred onto a laptop for analysis. The pre and post treatment acoustic parameters and VHI-10 scores were compared and correlated. There was significant difference (p < 0.001) between the pre and post treatment VHI-10 scores and all the acoustic parameters measured except for median pitch (p = 0.995). A poor positive correlation was found between the pre treatment VHI-10 scores and jitter(r = 0.188, p = 0.157) and shimmer (r = 0.288, p = 0.028) values. A negative correlation was observed between pre treatment VHI-10 scores and pitch (r = - 0.151, p = 0.259) and HNR(r = - 0.424, p = 0.001). Post treatment VHI-10 scores showed positive correlation with jitter (r = 0.302, p = 0.021) and shimmer (0.162, p = 0.225) values and negative correlation with pitch (r = - 0.10, p = 0.457) and HNR (r = - 0.356, p = 0.006) values. We found significant differences in the VHI-10 scores and PRAAT voice analysis results before and after treatment in patients complaining with voice change (dysphonia). VHI-10 questionnaire and PRAAT are good and convenient tools for assessing the voice subjectively and objectively. Only a poor to fair correlation was found between VHI-10 scores and PRAAT analysis results. More studies must be done to confirm the utility of smart phones as a voice acquisition device and PRAAT software in voice analysis.

Determinants of Cochlear Dysfunction in Chronic Otitis Media: Mucosal Disease.

The nature of association between chronic otitis media (COM)-mucosal disease and sensorineural hearing loss is controversial. Identifying the risk factors which influence the bone conduction threshold in these patients can help the clinician in counselling the patients for surgery at the earliest to achieve optimum hearing outcomes. The present study was undertaken to determine the association between COM-mucosal disease and cochlear dysfunction. The study also aimed at identifying the determinants and their influence on the bone conduction thresholds of the diseased ear. In this study, 72 patients with unilateral chronic otitis media-mucosal disease were enrolled consecutively. All patients were enquired in detail about their presenting ear symptoms. All the patients underwent a pure tone audiogram in a sound treated room. Patients were categorised into two groups according to the presence of conductive hearing loss only or with a sensorineural component. The bone conduction thresholds were calculated and compared for frequencies at 0.5, 1, 2 and 4 kHz. The average hearing threshold for air conduction and bone conduction were calculated across 0.5, 1 and 2 kHz. Bone conduction threshold more than 20 decibels (dB) in any of the frequencies were considered significant and indicative of having sensorineural hearing loss component. The contralateral healthy ear served as control to cancel out the confounding factors such as presbyacusis, noise induced hearing loss, congenital hearing loss, etc. Multivariate linear regression models were used to evaluate the relationships between bone conduction thresholds and chronic otitis media-mucosal disease. In the present study, 18.05% of participants had a sensorineural component. The difference between the bone conduction threshold in the diseased ear and normal ear ranged from 5.41 dB at 0.5 kHz to 3.77 dB at 4 kHz (p < 0.001). Bone conduction thresholds at 4 kHz were greater than that for speech frequencies (p < 0.5). 84.6% of participants with sensorineural component had a disease duration of less than 5 years and the remaining 15.4% had a duration of greater than 15 years. There was no statistically significant difference in the incidence of sensorineural component based on the site of the perforation (p = 0.341). 21.9% of participants who used topical antibiotic drops developed a sensorineural component, while 15% of participants who did not use antibiotic ear drop preparation developed a sensorineural component. Multivariate linear regression analysis revealed that increasing age was the only factor associated with increase in bone conduction thresholds of the diseased ear (p = 0.002). Chronic otitis media- mucosal disease appears to be associated with higher bone conduction thresholds, signifying cochlear dysfunction. A statistically significant higher bone conduction thresholds are seen across 0.5 to 4 kHz in the diseased ears compared to the normal ears, signifying the vulnerability of the inner ear against chronic otitis media. In our analysis increasing age is the most significant predisposing factor associated with higher bone conduction thresholds. Higher frequencies are more affected than lower speech frequencies. Sensorineural hearing loss can occur early in the disease process and early surgical intervention in COM-mucosal disease is recommended to prevent increase in bone conduction thresholds and achieve optimum hearing outcomes.

Lateral Stenosis of External Auditory Canal Secondary to Corrosive acid Injury: A Rare Case Report and Review of Literature.

Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review.

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

A Neglected Open Laryngeal Wound: A Rare Presentation of Neck Trauma.

Laryngotracheal trauma can be potentially lethal. Improper healing can have long term sequelae such as permanent voice change, laryngotracheal stenosis and impaired swallowing severely affecting an individual's quality of life. Thus early identification and prompt treatment is paramount to achieve good outcomes in laryngotracheal trauma. A 45 year old male presented with an open laryngeal wound 12 days after sustaining the injury. Surgical closure of the wound was done. A suprahyoid drop was done to achieve tension free repair of the laryngeal rent. Chin to chest sutures were used to maintain neck flexion in the post-operative period. We were able to achieve a good surgical outcome with regards to the patients voice, airway and swallowing in spite of the delayed presentation.

Retropharyngeal Lipomatous Hamartoma: Case Report and Review of Literature.

Introduction: Lipomas of the of the head and neck region are rare, more so in the retropharyngeal space. Lipomas in this region can produce symptoms that demand surgical excision. This paper describes a case of lipomatous hamartoma of the retropharynx, which to the best of our knowledge has not yet been reported in English literature. Case Report: A 53-year-old gentleman presented to the ENT department with snoring, voice change and stridor. Examination revealed a smooth bulge in the posterior wall of the oropharynx causing near complete obstruction of the airway. A contrast enhanced computed tomogram revealed a non-enhancing hypodense lesion in the retropharyngeal space extending from C1-C4 level, which was suggestive of a lipoma. The tumour was surgically excised trans-orally. A limited review of literature is also presented. Conclusion: Trans-oral approach is preferred to external approach for surgical removal of benign retropharyngeal tumours that cause obstructive symptoms, as our case. This approach is safe, effective, and associated with lesser post-operative morbidity.