Evaluation of swallowing in patients with T3/T4 oral squamous cell carcinoma.

Background: Follow-up of patients treated for head and neck cancer is an important part of the overall treatment. Oral cancers are one of the leading causes of dysphagia. Swallowing dysfunction occurs owing to the disease itself, its predisposing factors, and the treatment. This study aims to evaluate swallowing dysfunction in patients with oral cavity cancers. Methods: This prospective study was carried out in a tertiary care hospital institution. Thirty patients with T3, T4 oral cancers were evaluated using institutional dysphagia score and fiber optic endoscopic evaluation of swallowing (FEES) (Penetration-Aspiration Scale, Yale Pharyngeal Residue Scale) before treatment, after surgery, and after adjuvant therapy. Results: Advanced-stage tumor, larger resections, and adjuvant therapy are risk factors for dysphagia postoperatively. Although the dysphagia score is our institutional score, the results are promising, that is, 10 % of patients having symptoms at baseline evaluation, which increased to 60% and 70% after surgery and adjuvant radiotherapy respectively. Our study findings of the Penetration Aspiration Scale are 13% aspiration rate at the baseline evaluation, which increased to 57% and 73% after surgery and after adjuvant radiotherapy, respectively, and these results are consistent with those of other report studies. The Vallecular Residual Scale showed that there was a significant association between three different timelines and demonstrated dysphagia among study subjects. Conclusion: Subjective and objective assessment of swallowing dysfunction before and after the treatment of head and neck cancers is underreported and underrecognized. Most of the patients in our study had significant swallowing impairment after treatment. FEES is a very effective procedure to diagnose dysphagia and will help in incorporating better preventative and rehabilitative measures.

Identifying entrustable professional activities for post-graduation in ENT: What should an ENT specialist be able to do?

BACKGROUND: Though regulatory bodies of medical education in India mandate post graduate medical education to be competency based, the implementation of the same has not kept pace. The present study aims to develop and propose a set of entrustable professional activities for a masters degree in the discipline of ENT. It also attempts to present it in the form of a portfolio. METHODS: Experts in the subject went through a series of activities including brainstorming, discussions and internal peer review to shortlist and enumerate EPAs. RESULTS: 335 EPAs were identified and are presented. They were further classified as per need and expected expertise. CONCLUSION: The EPAs may serve as a guideline to medical colleges/institutions aiming to adopt competency based medical education in the post graduate curriculum in the subject of ENT.

Tracheal Stenosis: Evaluation of an Institutional Protocol and Introduction of Novel Surgical Criteria and Scoring System.

Treatment modalities for treatment of post intubation and post tracheostomy tracheal stenosis are many. However, well defined surgical criteria and prognostic classification eluding us till date. A prospective study of 57 cases of post intubation and post tracheostomy tracheal stenosis managed as per well defined surgical criteria followed in our institution. Patients were divided into three groups as per the primary surgical procedure used. The stenosis was classified into mild, moderate and severe based on our proposed prognostic classification. The success rate of endoscopic procedure was 81% with average 1.6 number of procedures per patient, for tracheoplasty success rate was 63% with 1.4 number of procedure per patient, and similarly for tracheal resection and anastomosis was 90% with 1.1 procedure per patient. The patient score as per our proposed classification correlated well with the prognosis. Our surgical criteria correlates well with success rate reported by other authors and can be helpful for institutions or surgeons dealing with tracheal stenosis occasionally. Our prognostic classification can be used to predict prognosis.

A Study of Effect of Consanguinity on Cochlear Morphology in Patients with Congenital Bilateral Profound Sensorineural Hearing Loss.

Consanguinity has been considered as one of the risk factors predisposing to the development of congenital hearing loss. Effect of consanguinity on cochlear morphology has been subject of speculation, though many studies have provided insight into functional aspect of cochlea. This study was conducted to know the effect of consanguinity on cochlear morphology, if any. A prospective, observational study, including prelingually deaf children with bilateral profound sensorineural hearing loss who are registered as candidates for cochlear implantation at a tertiary care centre, was conducted. Seven children born out of consanguineous marriages and having bilateral congenital sensorineural hearing loss were imaged for their inner ears by MRI and various cochlear measurements were compared with that of seven control children born out of non-consanguineous marriages and who had congenital bilateral sensorineural hearing deafness. No statistically significant differences were noticed in the measurements of mean cochlear length, cross sectional diameter of cochlea at apex, middle turn and at basal turns; between children born of consanguineous and non-consanguineous marriages. Study revealed normal cochlear morphology in all the children born out of consanguineous marriages. Consanguinity, as a risk factor for development of sensorineural hearing loss, may not result in gross structural anomaly of cochlea. The genetic testing of these patients need not be extensive and can be limited to selective screening of genes responsible for functioning of cochlea rather than its anatomical development.

A New Era of Diced Cartilage Rhinoplasty: Our Experience.

The use of diced cartilage grafts in reconstructive surgery was first described by Peer in 1943 though it was not for rhinoplasty. A number of studies describing diced cartilage have followed since then, but the technique has never achieved widespread use. In recent years, however, an interest in using diced cartilage for augmentation rhinoplasty has resurfaced. As surgeons revisit this technique, it is important that this technique is subjected to critical evaluation in terms of materials, approaches, and indications of using using diced-cartilage augmentation. External rhinoplasty approach with diced cartilage as a graft was used to for augmenting the nasal dorsum in 32 patients. Cosmetic appearance improved in all cases both subjectively and objectively. Only one patient showed constriction of dorsum 09 months after surgery. None of the patient had any intra-operative complication, 02 had donor site complication in the form of aural haematoma in 01 patient and wound infection in 01 patient. Diced cartilage technique is an attractive option for use in rhinoplasties especially those requiring augmentation procedures.

Bilateral orbital complications of paediatric rhinosinusitis.

BACKGROUND: The spread of infection from the ethmoid sinuses to the orbit occurs directly through a congenital dehiscence of the lamina papyracea or via haematogenous spread through ophthalmic venous system. Hence orbital complications of paediatric rhinosinusitis are usually unilateral at presentation. METHODS: We describe three children with bilateral orbital cellulitis that occurred as a complication of rhinosinusitis without intracranial spread of the infection. The children ranged in the age group from 4 to 7 years. All these children had a prolonged hospital stay from 14 to 25 days and underwent multiple surgical procedures to drain the subperiosteal abscess. These children presented to the hospital with bilateral orbital cellulitis without significant past history. All of them on radiological evaluation showed subperiosteal abscess involving only one orbit. They were taken up for functional endoscopic sinus surgery and the subperiosteal abscess was drained endoscopically with partial removal of lamina papyracea. One case required second surgery despite good recovery for two days post first surgery. RESULT AND CONCLUSION: Two cases had severe unilateral visual loss at presentation but both recovered dramatically after the surgery. All cases had uneventful recovery with no residual disability. The purpose of this article is to discuss the reasons for bilateral orbital complications of rhinosinusitis at initial presentation despite the previous hypothesis of unilateral involvement.

Role of Laryngeal Electromyography in Predicting Recovery After Vocal Fold Paralysis.

Accurate prognostication of the outcome of vocal fold immobility assumes great importance in the management. This study aimed to evaluate the prognostic efficacy of Laryngeal electromyography in cases of vocal fold immobility. A nonrandomized prospective study was carried out from Sep 2009 to Jun 2011. Patients were evaluated using Fiberoptic laryngoscopy and Laryngeal electromyography over a period of 24 weeks. 51 subjects participated in the study, comprised of 22 males and 29 females. All patients underwent detailed clinical examination including Fiberoptic laryngoscopy on the first visit and Laryngeal electromyography testing on the second visit. Subsequent neuromonitoring was carried out at 04, 12 and 24 weeks from date of initial recording. Outcome measures of vocal fold motion were dichotomized into persistent vocal fold immobility (unilateral or bilateral) or resolved vocal fold motion (normal). Approximately 24 weeks after onset of palsy, mobility of the paralyzed vocal cord was restored in 31 (60.78 %) of 51 cases, while 20 (39.22 %) remained immobile. Sensitivity of laryngeal electromyography was 92.53 % ; specificity 93.33 %, positive predictive value 98.77 % and negative predictive value 68.29 %. This study confirmed the utility of Laryngeal electromyography in predicting prognosis for recovery of vocal fold motion after laryngeal nerve injury. The results supported the hypothesis that Laryngeal electromyography data can be used effectively to determine a prognosis for recovery of vocal fold motion.

Facial nerve paralysis: A three year retrospective study.

Of all the cranial nerves, the facial nerve is the one which is most commonly involved in disease. Facial paralysis leaves the patient severely disfigured. Timely diagnosis and treatment can lead to considerable recovery. 16 consecutive patients of facial paralysis of all age groups and due to different causes diagnosed and treated in a tertiary referral hospital have been studied retrospectively. The frequency of aetiological factors, the various factors governing the management of these cases and their actual outcomes after a minimum period of one year are discussed. The causes of facial nerve palsy included cholesteatomas, Bell's Palsy, iatrogenic, traumatic, neuroma and others. In general, early reporting, diagnosis and surgical intervention wherever indicated have resulted in better recovery. Surgical decompression of the facial nerve traditionally advocated have been questioned. Rare causes of facial nerve paralysis like postoperative BIPP pack allergy and bilateral congenital agenesis of facial nerve are also included.

Clinico-pathological correlation study of cervical lymph node masses.

One hundred and ten cases of cervical lymph node masses were subjected to clinical evaluation and aspiration cytology. Eighty six cases which subsequently underwent open biopsy were subjected to histopathological evaluation. Accuracy, specificity and sensitivity of clinical diagnosis were 86.1%, 93.6% and 91.1% respectively as compared to 88.3%, 97.6% and 93.6% respectively for aspiration cytology. Reliability coupled with other advantages makes aspiration cytology the first line investigation in evaluating cervical lymph node masses reserving open biopsy for certain specific indications. Based on the conclusions a protocol is being recommended for evaluation of cervical lymph node masses.