Diagnostic Delay in Pediatric Vestibular Disorders.

BACKGROUND: Vertigo and dizziness in children can be multi-factorial. Vestibular function tests allow an improved differential diagnosis and treatment. Delay in diagnosis of the diverse etiologies causing dizziness can adversely affect the health of children and is a matter of concern for their families. This study analyzes the delay in diagnosis and the importance of establishing a diagnosis with detailed history and neuro-otological evaluation. METHODS: A total of 241 children presenting with vertigo to a tertiary otoneurology clinic between January 2019 and April 2022 were analyzed for the duration between the onset of symptoms and diagnosis, presenting complaints, and characteristic findings. RESULTS: Two hundred and forty-one patients with a mean age of 12.5 ± 3.02 years (range, 5-16 years) were evaluated. About 39.4% of patients were diagnosed after over a year (with some over 5 years) of suffering from vertigo and only 18.7% of patients were diagnosed correctly within 1 month of symptom onset. The presenting features were variable with 174 (72.2%) complaining of spinning, unsteadiness, and falls seen in 36+10+37 (34.4%). Vestibular migraine was the most common diagnosis (63.39%), followed by benign paroxysmal positional vertigo (24.48%), of which the posterior canal was most affected (50.85%) followed by horizontal (40.68%) and anterior canal (8.47%). Other etiologies noted were central (14.10%) and peripheral vestibulopathy (17.42%) and variable other causes (6.19%). CONCLUSION: Many pediatric vertigo and dizziness patients do not reach the correct diagnosis for long durations and are treated as "unspecified dizziness." A detailed examination with a multidisciplinary approach including vestibular evaluation is advocated to give definitive treatment to these children.

Hearing Outcome After Incudo-stapedial Joint Reconstruction Using Conchal Cartilage Interposition Graft.

Ossicular chain defects secondary to Chronic otitis media most frequently involves the incudo-stapedial joint. This study observes the effect of incudo-stapedial joint reconstruction using conchal cartilage interposition graft on hearing of the patient. Fifty-three patients with chronic otitis media of inactive mucosal type with incudostapedial necrosis of less than half of long process of incus were posted for tympanoplasty with incudostapedial joint reconstruction using autologus conchal cartilage. Their hearing outcome was analysed by comparing the pre-operative and 12 weeks post-operative Pure Tone Audiogram. A statistically significant improvement is seen in air conduction by 14.66 dB after incudo-stapedial joint reconstruction using conchal cartilage (p value 0.0001), whereas improvement seen in bone conduction was statistically insignificant. 52 (98.1%) patients had ≤ 40 dB post-op AC and 1 (1.9%) had > 40  dB.. Conchal cartilage is an easy-to-harvest, biocompatible and cost effective graft material. It gives hearing results comparable to other materials.

Subcutaneous Randomized Nasolabial Flap: Our Experience.

Nasolabial flaps are one of the oldest methods of reconstruction. This study aims to observe the viability of a random-pattern subcutaneous nasolabial flap. Inpatients of carcinoma of oral cavity and nose undergoing excision with primary reconstruction from January 2014 to December 2019 were observed and followed-up. Their data including site of primary and post-operative complication was recorded. A total of 38 patients underwent reconstruction using nasolabial flap. Most cases were of buccal mucosa carcinoma (68.4%). Facial vessels were ligated in all except 7 cases and, only 1 (2.6%) showed total, and 3 (7.9%) showed partial flap necrosis. A subcutaneous nasolabial flap is simple, viable and easy to harvest. It is a random-pattern flap therefore; facial vessel preservation may not be a compulsion. Flap raised subcutaneously is thinner and thus inset is easy and bulk associated discomfort is avoided.

Anomalous Subarcuate Canal and Artery: A Rare Anatomical Variation.

Introduction: An aberrant or anomalous subarcuate artery and its canal is an extremely rare and clinically significant finding. If accidentally nicked or injured, it can cause inadvertent hemorrhage and obscure the surgical field. Case Report: We present a case of 21 year old made with Chronic Otitis Media of the right ear who was incidentally diagnosed with a dilated subarcuate canal and an aberrant subarcuate artery atypically associated with lateral semicircular canal and facial nerve. Conclusions: Prior knowledge of this symptomatically dormant variation is important, particularly in retrofacial tympanomastoidectomy and cerebello-pontine angle tumor surgeries. Pre-operative temporal bone scans are advisable in such cases.

Olfactory and Gustatory Dysfunction in Covid-19: An Observational Study in a Tertiary Care Institute of Western Rajasthan.

Coronavirus causes damage to chemosensory receptors resulting in olfactory and gustatory dysfunction. This study reports our observations on anosmia and ageusia in symptomatic COVID-19 positive patients admitted in the COVID centre of Western Rajasthan. A total of 98 symptomatic, RT-PCR positive COVID-19 patients admitted in the M.G. Hospital during November 2020 were evaluated with detailed history regarding symptoms along with duration and resolution including response to antiviral therapy. Olfactory and Gustatory dysfunction was seen in 53.1% patients. Both anosmia and ageusia coexisted in 61.5% patients followed by isolated anosmia (25%), while isolated ageusia was rare. History of preceding fever was present in 69.2% cases. 100% of the patients with ageusia had loss of salty and sour taste, while 90.1% did not feel sweet taste. Bitter taste sensation was altered only in 63.6%. Symptoms reversed within 7 days in 94.2% cases and after 15 days in 5.8% cases irrespective of antiviral therapy. Chemosensory dysfunction has no racial predominance. It is a self-limiting manifestation and a useful screening symptom. Co-existence of anosmia and ageusia is more common than isolated dysfunction. In ageusia, salty and sour is the most commonly lost taste sensation followed by sweet.

Microbiology of Chronic Otitis Media and Shifting Trends of Its Antibiotic Susceptibility: A Prospective Observational Study in a Tertiary Care Institute of Western Rajasthan.

COM is a prevalent disease in lower socio-economic group mainly of a developing country. COM in active stage presents with a discharging ear. The mucopus from an active ear, when put through microbiological culture, yields a variety of aerobic and anaerobic bacteria as well As fungi. Antibiograms provide us with culture specific antibiotics. The study aims to identify prevalent microbes in our region and their sensitivity towards respective antibiotics. A total of 100 patients diagnosed with active COM in the E.N.T. outpatient department of M.D.M. Hospital, Jodhpur from July 2019 to December 2019 were enrolled. 100 swabs were obtained, one from each patient, using sterile cotton swabs and cultured for microbial flora. Antibiotic susceptibility testing of bacterial isolates was done using Kirby-Bauer disc diffusion method. The most common organism isolated were Pseudomonas spp. (58%) and Staphylococcus aureus (25%), while 8% were fungal isolates. The sensitivity pattern of Pseudomonas spp. was maximum for meropenem while that of Staphylococcus species was maximum for linezolid and vancomycin. Both were fairly sensitive to amikacin, cephalosporins and Quinolones. Culture specific antibiotics help us achieve dry ear faster and better. There is a drifting trend in antibiotic susceptibility of both aerobic and anaerobic species, towards higher group of antibiotics. Thereby suggesting emergence of multi-drug resistant strains.