The outcome of fluticasone nasal spray on anosmia and triamcinolone oral paste in dysgeusia in COVID-19 patients.

BACKGROUND: To study the outcome of fluticasone nasal sprays in smell disorders and triamcinolone paste in taste dysfunction in a population of laboratory-confirmed SARS-CoV-2 patients as the test group. The control group will not be given any intervention and only monitoring of these symptoms will be done to compare the recovery time. METHODS: This prospective interventional study was conducted from June to Nov 2020 at, Datta Meghe University during the COVID-19 outbreak. The 120 enrolled patients were tested at days 1 and 5 after proven infection by RT-PCR test. RESULT: The mean age for all cases is 50.88 ± 15.93 years, whereas for the controls mean age is 51.2 ± 14.89. 2. Among cases 45 (75%) were males and 15 (25%) were females, among controls 43 (71.66%) were males and 17 (28.33%) were females. Among the case group, after the use of fluticasone spray in the nose and triamcinolone paste in the mouth there was a statistically significant improvement in recognizing all the odours and taste on day 5 compared to day 1. On comparing the smell and taste of cases and control group, either there is no improvement or worsening in smell or taste on day 5 in the control group. CONCLUSION: The use of fluticasone nasal spray and triamcinolone paste had immensely influenced the basic senses such as smell and taste. Our study showed that olfactory and taste function significantly improved in patients with COVID-19. For all anosmia and dysgeusia cases who received fluticasone nasal spray and triamcinolone medications the recovery of smell senses and the taste was within a week.

Tumour volumes: Predictors of early treatment response in locally advanced head and neck cancers treated with definitive chemoradiation.

AIM: To analyse and predict early response 3 months post definitive chemoradiation (CCRT) utilising tumour volume (TV) measurement in locally advanced head and neck cancers (LAHNC). BACKGROUND: LAHNC are 3-dimentional lesions. The largest diameter of these tumours measured for T-classification may not necessarily reflect the true tumour dimensions. TV accurately reflects the tumour burden because it is a measurement of tumour burden in all three dimensions. MATERIALS AND METHODS: It is a single institutional prospective study including 101 patients with LAHNC treated with definitive CCRT. TV data noted were primary tumour volume (PTV), total nodal volume (TNV) and total tumour volume (TTV). Response evaluation was done at 3 months after the completion of definitive CCRT and patients were categorised either having achieved complete response (CR) or residual disease. RESULTS: Patients who had not achieved CR were found to have larger TV compared with those who had achieved CR. There were significant inverse correlations between PTV and response (median 16.37 cm(3) vs. 45.2 cm(3); p = 0.001), and between TTV and response (median 36.14 cm(3) vs. 66.06 cm(3); p < 0.001). Receiver operating characteristic (ROC) analysis identified an "optimal cut-off" value of 41 cm(3) for PTV and 42 cm(3) for TTV above and below which the magnitude of difference in response was the greatest. CONCLUSIONS: If response evaluation 3 months post CCRT is to be predicted it is simply not enough to measure the largest single dimension of the tumour. TV seems to be a better and more accurate reflection of the true total tumour burden or extent of the disease.

Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India.

INTRODUCTION: Hypomagnesemia has been common, but mostly underdiagnosed electrolyte abnormality. Studies regarding this is lacking in India especially in rural setting. Here, we have correlated serum magnesium (Mg) level with outcome in patients of medicine Intensive Care Unit (ICU) with respect to length of ICU stay, need for mechanical ventilatory support and its duration and ultimate outcome (discharge/death). MATERIALS AND METHODS: This is a prospective observational study carried out over a period of 1-year enrolling 601 patients of Medical ICU (MICU). The Chi-square test is applied to correlate hypomagnesemia with the outcome. RESULT AND OBSERVATION: About 25% patients had admission hypomagnesemia. When compared with the normal Mg group, there was significant association of hypomagnesemia with outcome in terms of duration of MICU stay 5.46 (5.75) versus 3.93 (3.88), need for mechanical ventilation (56.86% vs. 24.33%), discharge/cured from ICU (61.43% vs. 85.26%), and death (38.56% vs. 14.73%). However, no significant difference was found in the duration of ventilation between the two groups. CONCLUSION: Hypomagnesemia is associated with a higher mortality rate in critically ill patients. The need for ventilatory support, but not its duration is significantly higher in hypomagnesemic patients. Hypomagnesemia is commonly associated with sepsis and diabetes mellitus. The duration of MICU stay is significantly higher in patients with low serum Mg.

Wildervanck syndrome with hypoplastic frontal sinus: A rare case presentation.

We report a case of Wildervanck syndrome exhibiting Klippel-Feil anomaly, Duane's retraction syndrome and congenital deafness. Since the first case was reported in 1952, there have been more reports describing this triad either complete or incomplete. Our case has a complete triad of the syndrome along with frontal sinus hypoplasia. Our case is unique as the triad was associated with frontal sinus hypoplasia, which is very rare association.

Rhinomanometry: A Comprehensive Review of Its Applications and Advancements in Rhinology Practice.

Rhinomanometry is a pivotal diagnostic technique in rhinology, providing a quantitative assessment of nasal airflow and resistance. This review comprehensively examines the historical development, principles and clinical applications of rhinomanometry, emphasising its role in diagnosing nasal obstructions, preoperative evaluations and monitoring therapeutic outcomes. Recent advancements, including the integration with imaging technologies and the application of artificial intelligence (AI), have significantly enhanced the accuracy and utility of rhinomanometry. Despite facing challenges such as technical limitations and the need for standardisation, rhinomanometry remains an invaluable tool in both clinical and research settings. The review also explores future directions, highlighting the potential for device miniaturisation, telemedicine integration, personalised protocols and collaborative research efforts. These advancements will likely expand the accessibility, accuracy and clinical relevance of rhinomanometry, solidifying its importance in the ongoing evolution of rhinology practice.

The Role of Diet and Lifestyle in the Tinnitus Management: A Comprehensive Review.

Tinnitus, the perception of noise or ringing in the ears without an external source, affects a significant portion of the global population. While there is no definitive cure, emerging research suggests that diet and lifestyle factors may play a role in tinnitus management. This comprehensive review explores the relationship between diet, lifestyle, and tinnitus, examining the existing evidence and potential mechanisms. The key findings highlight the influence of dietary patterns, hydration, stress management, physical activity, and sleep hygiene on tinnitus severity and frequency. Personalized approaches to tinnitus management are emphasized, recognizing the diverse nature of tinnitus symptoms and individual responses to interventions. Healthcare professionals are encouraged to integrate discussions about diet and lifestyle into tinnitus management protocols, while individuals affected by tinnitus are urged to adopt healthy habits and actively participate in their care. By addressing the multifaceted nature of tinnitus, healthcare professionals and individuals can collaborate toward optimizing symptom management and enhancing overall well-being.

Unveiling the Potential: A Comprehensive Review of Dynamic Slow-Motion Video Endoscopy for Eustachian Tube Dysfunction Evaluation.

Eustachian tube dysfunction (ETD) poses diagnostic challenges due to its complex pathophysiology and varied clinical presentation. Traditional diagnostic methods often lack direct visualization of the Eustachian tube (ET) function, leading to suboptimal evaluation and management. Dynamic slow-motion video endoscopy (DSVE) has emerged as a novel approach to address these limitations, offering real-time visualization of ET dynamics with enhanced clarity and precision. This comprehensive review provides an overview of DSVE as a promising tool for evaluating ETD. We discuss its methodology, clinical applications, comparative analysis with traditional methods, and future directions. Key findings from the literature highlight DSVE's ability to enhance diagnostic accuracy, facilitate targeted treatment strategies, and improve patient outcomes. Integrating DSVE into routine clinical practice holds significant implications for the diagnosis and management of ETD, offering clinicians valuable insights into underlying pathophysiology and guiding personalized treatment interventions. Future research should focus on standardizing DSVE protocols, validating its diagnostic accuracy, and exploring its role in guiding novel treatment modalities. By advancing our understanding of ETD and optimizing diagnostic and therapeutic approaches, DSVE has the potential to revolutionize the management of this common yet challenging otologic condition.

Klippel-Feil Syndrome With Isolated Facial Dysmorphism: A Clinical Conundrum With Resemblance to Adenoid Facies.

Klippel-Feil syndrome (KFS) is a triad comprising cervical spine fusion, a low posterior hairline, and constrained neck movement. This triad is not universally present. The most frequent accompaniment is Sprengel's scapula deformity. According to the Feil classification, Class 1 (C1) is an immense fusion of many cervical vertebrae, Class 2 (C2) is a fusion of one or two vertebrae only, and Class 3 (C3) is coupled with thoracic and lumbar spinal vertebral fusion in addition to the fusion of the cervical vertebrae. Clarke's categorization of KFS includes other associated anomalies. The different classification systems for KFS have been made by the different specialists to whom patients may present, which include orthopedic surgeons, neurosurgeons, orthodontists, faciomaxillary surgeons, cardiologists, and pediatricians. This anomaly being rare and the lack of universally accepted classification may lead to confusion regarding the identification of the syndrome, especially the Clarke Type 3 with isolated facial dysmorphism may go undiagnosed. We report a case with KFS-Clarke Type 3 with isolated facial dysmorphism and Feil Type 2 with the fusion of C2-C3 cervical vertebrae, detected as an incidental radiologic finding, and initial impression of adenoid facies. Hence, this case also highlights the contrasting features between the facial dysmorphism of Clarke Type 3 KFS and adenoid facies.

Post-burn Cervicofacial Necrotizing Fasciitis With Diabetic Ketoacidosis: A Report of a Case With a Favorable Outcome.

Post-burn necrotizing fasciitis (PBNF) is a serious and potentially life-threatening infection that occurs after a burn injury. It is characterized by rapid destruction of soft tissue and muscle and is usually caused by a bacterial infection. Diabetic ketoacidosis (DKA) is another serious complication of diabetes, which can occur when the body does not have enough insulin to break down glucose for energy. This causes the body to start breaking down fat for energy instead, leading to various complications. The present study discusses the association between PBNF and DKA in a patient with diabetes. Here is a case of a post-auricular abscess and a precipitated DKA. The abscess was located near the site of the previous burn injury that happened 20 years ago and was believed to have developed as a result of thick scar tissue. The patient was given adequate hydration, intravenous antibiotics, and insulin therapy. However, the abscess continued to grow with increasing insulin requirements and the patient underwent incision and drainage to remove the infected tissue, and an aggressive debridement was carried out. Thus, this case highlights the importance of closely monitoring blood sugar levels in patients with a history of burn injury and diabetes, as well as the potential for infections to precipitate DKA. Timely intervention, including incision and drainage, can lead to successful resolution of symptoms and improved outcomes.

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway.

Frontal osteomyelitis is characterized by localized osteal inflammation of the frontal bone. This is a rare complication of acute frontal sinusitis. The present case is being reported to highlight the likely role of anatomical variations in frontal sinus drainage pathways in the causation of this complication apart from other known predisposing factors like young age and immunocompromised state. The patient initially presented with seizures, fever, and headache and was diagnosed with viral encephalitis. However, the symptoms gradually progressed to cause right eye swelling and an increase in the severity of headache without any nasal complaints. Diagnostic nasal endoscopy revealed mucopurulent secretions in both nasal cavities. Computed tomography and magnetic resonance imaging diagnosed the anatomical variations, the extent of sinus involvement, and frontal osteomyelitis. Antimicrobial therapy for an extended duration of four weeks, along with functional endoscopic sinus surgery resulted in excellent outcomes.

Small Cell Non-keratinizing Neuroendocrine Carcinoma Involving the Larynx and the Base of the Tongue: A Rare Case With a Locally Aggressive Spread.

Squamous cell carcinoma is the most predominant type of malignancy in the head and neck region with neuroendocrine carcinomas (NECs) being a rare occurrence. Here we report a rare case of small cell non-keratinizing NEC (WHO grade 3), TNM (tumor, node, and metastasis) stage T3N1M0, involving the larynx and the base of the tongue, in a 54-year-old male patient, demonstrating its rarity in an uncommon anatomical site and an aggressive and relatively uncommon pattern of spread for this tumor, over a period of two months. NECs in the head and neck region, especially those affecting the larynx and the posterior third of the tongue, remain exceedingly rare, comprising only a small fraction of malignancies in this region. The aggressive nature and distinct pattern of spread observed in this case underscore the importance of recognizing such unusual presentations for appropriate diagnosis and management. Given the rarity of this tumor type, a comprehensive understanding of its clinicopathological features is essential for guiding effective treatment strategies. We also discuss the treatment.

Pattern and Severity of Allergic Rhinitis Correlated with Patient Characteristics: A Rural Hospital-Based Cross-Sectional Study.

Allergic Rhinitis (AR) is rising in incidence in both developed and developing countries. Genetics and epigenetics have a potential role to play. The pattern and severity of AR have implications with regard to choice of treatment, which itself could be related to patient specific genetic and epigenetic factors. Hence, the present study was undertaken to correlate the patient characteristics with AR pattern and severity, in order to understand the pathophysiology of AR. The study also aimed to find out the allergen sensitivity pattern among patients attending a tertiary care centre of rural central India, where climatic variations make it a high prevalence zone. Prospective Observational study on 90 patients with clinically diagnosed Allergic Rhinitis confirmed by Skin Prick Tests. Patient characteristics like demographic data, data relevant to allergen exposure, occupation, family history of atopy and gender; and Disease characteristics like severity (mild, mod-severe), pattern (continuous/ intermittent), type of disease (seasonal/perennial) were noted, analysed and correlation studied. Majority of the patients with AR were in the age group of 15-40 years. Medical students (52%) suffered from moderate to severe type of Allergic Rhinitis, with Persistent disease in approximately 80%. Similarly, 70.59% of farmers had moderate to severe type of the disease, with persistent disease in 70%. In the present study, in clinically diagnosed allergic rhinitis patients, Mite was the commonest allergen found on Skin Prick Test overall and in Medical students, whereas Pollen sensitivity was more common among farmers. 56.66% of the patients had negative family history of atopy. Severity and type of AR depend on allergen exposure. In farmers and medical professionals, persistent and moderate to severe type of disease was more common, as they were persistently exposed to different type of allergens, mites in case of medical professionals and pollens in farmers. Hence, the Disease characteristics, as defined by ARIA guidelines, should not be taken in isolation and management should consider the Patient characteristics for deciding and devising protocols. In the present study, more than 50% patients were without family history of atopy. Hence, the role of various environmental factors, leading to epigenetic changes could be a major contributor in the increase in incidence of allergic rhinitis in recent times. Occurrence of perennial moderate to severe form of disease, in majority of farmers, defies the phenomenon of "Hygiene Hypothesis", focusing on the role of epigenetic changes and various outdoor allergens in the development of allergic rhinitis in them.

Nasal Herpes Simplex With Infraorbital Neuralgia: A Rare Presentation.

Facial herpes is a form of herpes simplex type I infection and presents with characteristic vesicular lesion around the perioral region. Nasal herpes, a form of facial herpes is a rare presentation with only a few cases reported in the literature. Neuralgic pain in herpes simplex is usually experienced at the site of the lesion during or before the eruptive stage. Here, we are reporting a case where the patient with a herpes simplex lesion over the tip of her nose presented with pain over the infraorbital region, which is a region supplied by the infraorbital nerve, a branch of the maxillary division of the trigeminal nerve. Initially confused as a bacterial infection due to its unusual presentation and rarity of the condition, the patient was given anti-bacterial therapy, but on showing no relief in symptoms, the patient was treated with appropriate antiviral drugs, following which complete remission of the lesion was observed. The case highlights a rare site for a common condition and atypical presentation.

Infectious Mononucleosis Presenting as Near-Fatal Tracheal Obstruction.

Infectious mononucleosis (IM) caused by Epstein-Barr virus is a self-limiting condition and usually carries a benign course. It is usually seen in adolescents and young adults. However, complications can occur in a small percentage of patients such as splenic rupture, myocarditis, and meningitis. Tracheal obstruction as a result of IM is extremely rare. In this case report, we highlighted a rare complication of nearly fatal tracheal obstruction in a young patient of IM that was managed timely by emergency tracheostomy.

A Rare Association of Pituitary Macroadenoma With Nasopharyngeal Angiofibroma: A Case Report.

Pituitary macroadenoma and angiofibroma are two distinct and diverse types of tumors that can develop in different anatomical locations and clinical characteristics and are not typically related to each other in terms of their hormonal or developmental aspects. This case describes an adult male with pituitary macroadenoma with nasal angiofibroma. A 35-year-old male was diagnosed with pituitary macroadenoma and incidentally found to have juvenile nasopharyngeal angiofibroma (NPA). The patient underwent a diagnostic workup, including imaging studies and hormonal assays, which confirmed the concomitant presence of both tumors. The patient underwent successful endoscopic surgical excision of the NPA and transnasal transsphenoidal endoscopic pituitary macroadenoma excision as a two-stage operation. The patient was followed up postoperatively and had no evidence of tumor recurrence or hormonal imbalances. The importance of complete and comprehensive diagnostic workup and multidisciplinary management in achieving successful and optimum treatment outcomes for coexisting NPA and pituitary macroadenoma in an adult patient is highlighted in the present report.

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

INTRODUCTION: Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. METHODS: A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. RESULTS: Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. CONCLUSION: The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium." Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.

An Overview of Psychological Analysis of Breast Cancer Patients undergoing Modified Radical Mastectomy and Breast Conservation Surgery and its impact on Objectified Body Consciousness at a Tertiary Care Cancer Centre in South India.

BACKGROUND: Breast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women's mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types. MATERIALS AND METHODS: This retrospective analysis of prospectively maintained data included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Modified Radical Mastectomy at tertiary care Cancer Centre, between the years 2020 to 2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t-tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively. RESULTS: Out of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Modified radical mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22 ± 15.44) for all patients when compared preoperatively(72.72 ± 11.38) and postoperatively(60.15 ± 17.58). This change was higher in the Modified Radical Mastectomy group(29.38 ± 11.53). Also, statistically significant rise in scores was seen with increasing age. CONCLUSION: We could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a Modified Radical Mastectomy, had more psychological apprehension with the body image postsurgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest.

Seroma of Auricle.

The pseudocyst of the auricle is an intracartilaginous lesion defined as the accumulation of sterile, straw-coloured fluid in a cyst unlined by epithelium. It is more common in males. The most common site of lesion is the scaphoid fossa and right ear. Though the aetiology remains unclear, it may be associated with mechanical irritation, repeated minor injuries and chronic trauma. If left untreated, it can lead to permanent deformity of the auricle. Pseudocyst of the auricle is a rare and challenging condition. Medical management has unfortunately shown no practical results. Hence, surgical treatment modalities are the best option. The universal aim of treatment is the conservation and restoration of the anatomical structure of the pinna, removal of cystic lesions and prevention of recurrence. Simple aspiration or incision and drainage alone lead to reaccumulation of cystic fluid in most cases. The technique of incision and drainage is the easiest but has a high recurrence rate. Conservative treatment often results in recurrence and unsatisfactory results. Other treatment modalities include incision and drainage with daily irrigation, auricular splinting, aspiration with intralesional steroid injection, aspiration followed by compression dressing, or aspiration with intralesional steroid injection followed by compression dressing and surgical deroofing, surgical deroofing followed by compression with buttons or sheet or sandwich method. Cysts with a diameter less than 1 cm are dealt with through non-surgical treatment modalities, while for cysts having a diameter greater than 1 cm, surgery is considered as first choice therapy. These treatment options have shown promising results. Various modifications in the traditional techniques have reduced the recurrence rate, successfully treated the condition and shown good cosmetic results. This review article aims at providing a holistic collection of various conventional treatment modalities and novel modifications introduced, which can be used in a sequence of definitive treatments of seroma of the auricle.

Management of Stridor in Severe Laryngomalacia: A Review Article.

Laryngomalacia is the term most broadly used to portray the "internal breakdown of structures of supraglottis of the larynx at the time of inspiration. It is often associated with stridor during inspiration, which is of a high pitch at the time of birth and comes into notice by 14 days. When there is an increase in breathing, stridor worsens, and it is usually position-dependent. Laryngomalacia means the weakening of the larynx resulting in a collapse of the laryngeal cartilages, especially the epiglottis, into the airway. This partially occludes the upper airway during inspiration and causes inspiratory stridor. The exact etiology of the condition is not known. It is a well-known cause of noisy breathing in neonates and infants. The common presentation is a neonate with flushing and high-pitched inspiratory stridor that is usually noticed before 14 days of age. This worsens with breathing and supine positioning and improves in a prone position. Less commonly, it can present with hypoxia, feeding problems, aspiration, and failure to thrive. The condition may increase in severity during early life but usually self-resolves by two years of age. The hiccup-like squeak of laryngomalacia during inspiration is due to unsettled air flowing through the laryngeal passage. The condition is diagnosed with laryngoscopy, and the treatment varies with presentation and severity. Neonates with the uncomplicated disease can be treated expectantly. Those presenting with feeding problems and gastroesophageal reflux will require acid suppression. Severe complications like aspiration, severe airway obstruction, and hypoxia will require surgical treatment, including supraglottoplasty. In cases where the surgical treatment failed, noninvasive ventilation can be advised. The article reviews the various medical and surgical interventions and the management of severe laryngomalacia.