Preparation of nose for nasal endoscopy: cotton pledget packing versus topical spray. A prospective randomized blinded study.

During nasal endoscopy it is essential to have proper visualization of structures with minimal discomfort to patient and surgeon. For this it is essential that the nose is well prepared before the procedure. The main objective of the study is to compare and evaluate the efficacy of cotton pledget packing versus topical sprays in preparation of nose for nasal endoscopy. The method includes prospective randomized blinded study on 100 patients. Patients were randomly divided in two groups. In first group the nose was packed with 4% lignocaine with xylometazoline nasal drops and in the other group it was prepared with 10% lignocaine topical spray and xylometazoline nose drops. Following the procedure, patient and the surgeon were asked a pre-formed questionnaire to know their experience during endoscopy. It was observed the packing group required more preparatory time as compared to the spray group. The group which was packed had less discomfort, less pain while endoscopy. The visualization of structures was significantly better in the packed group. Eight patients in the packed group did have some mucosal bleed during the process of packing which was not seen in the spray group. Both methods of preparation have merits and demerits but in terms of discomfort, pain during procedure and visualization of structure, packing of nasal cavity with 4% lignocaine and xylometazoline drops is better than spraying of nose with 10% lignocaine and xylometazoline drops.

Use of Silicon T-Tube for Subglottic Stenosis and Tracheal Stenosis.

Introduction: The management of subglottic and tracheal stenosis is challenging for any ENT surgeon. The treatment choice depends on the site, severity of stenosis, patient symptoms, and surgeon preferences. The various options for the management include endoscopic balloon dilatation, various types of laryngotracheoplasty, resection anastomosis, and insertion of a silicon T-tube. Compared to the above, silicon T-tube stenting is a better alternative, as it is a onetime procedure, easy to perform with fewer chances of complications. Shiann Yann lee technique is a form of laryngotracheoplasty with long-term stenting using silicon T-tube. This article analyzed our silicon T-Tube insertion result in patients with subglottic and tracheal stenosis using this technique. Materials and Methods: In this retrospective study, we included a total of 21 patients with subglottic and tracheal stenosis who underwent silicon T-Tube insertion. Data regarding the site of stenosis, procedure, complications, and outcome were analyzed. Results: Out of 21 patients, nine patients had subglottic stenosis (42.8%), 8 had cervical tracheal stenosis (38.09%), 3 had thoracic tracheal stenosis (14.28%), and 1 (4.7%) had combined subglottic and cervical tracheal stenosis. Out of 21 patients,7 (33.3%) have undergone successful removal of silicon T-Tube so far, one death due to medical reasons, and 13 patients (61.9%) are still on Silicon tube on regular follow-up. They are comfortable with the tube in situ. Conclusions: Silicon T-Tube for benign acquired laryngotracheal stenosis with Shiann Yann Lee's technique is effective, safe with less complication, and good acceptability and tolerance by the patient.

Epleys Versus Semonts Manoeuvre in Posterior Canal Benign Paroxysmal Positional Vertigo.

Introduction: Benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder is characterized by short-lived episodes of rotatory vertigo in association with rapid changes in head position. Diagnosis of BPPV is clinical. The principle of treatment of BPPV involves maneuvers comprising of head movements, in order to bring the free debris from the semicircular canal back to the utricle. In this study we tried to evaluate and compare Epleys and the Semonts manoeuvre in the treatment of Benign paroxysmal positional vertigo of the posterior semicircular canal in terms of subjective and objective improvement. Materials and methods: Study Design: This prospective randomized study included 200 vertigo patients attending ENT OPD of tertiary care centre with Dix Hallpike positive status. (September 2017 -August 2019). Objective improvement was compared in terms of Dix Hallpike positivity between both groups on weekly follow up for four weeks. Subjective improvement was compared in both the groups by dizziness Handicapp index ( DHI) on follow-ups. Results: Total 200 patients formed part of study, with 100 in each group. On comparing Dix Hallpike positivity between both groups on weekly follow ups there was no significant difference between both the groups. DHI, compared between both groups showed that Semonts Maneouver was significantly better. Conclusion: In patients of BPPV both Epleys and Semonts are equally effective objectively. However the subjective improvement was better in patients on whom Semonts manoeuvre was performed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03624-5.

Outcome of Tracheostomy in COVID-19 Patients.

Introduction: Since the start of the COVID-19 pandemic 2019, quite a few patients became critical and needed ICU admission with ventilator assistance. Tracheostomy, which was initially performed late during the course of patient on ventilator, has now been considered a procedure that can be performed relatively early as this leads to early weaning of patients and overcomes the shortage of critical beds. Objective: This study aims to focus on the outcomes of tracheotomised COVID-19 patients in terms of survival and any tracheostomy related morbidity. Methods: A prospective study was performed on COVID-19 patients undergoing tracheostomy at this tertiary care teaching hospital, which also was a dedicated centre for treating COVID-19 patients. The duration of this study was from April 2020 to September 2021. Following tracheostomy, all patients were followed up regularly and clinical changes were recorded. Points that were specifically noted were timing of the tracheostomy, change in ventilator settings, tracheostomy related complications, requirement of oxygen, days needed to wean the patient, decanulation, and, if death, the cause of death. Results: A total of 136 surgical open tracheostomies were performed on COVID-19 patients over the study period. The mean duration of intubation (timing of tracheostomy) was 12 days. A total of 73 out of 136 (53.6%) patients survived. 51 patients (37.5%) got decannulated during the course of the hospital stay. 9 patients were decanulated during the follow up visits and 13 patients were lost to follow up. 63 out of 136 (46.3%) patients died due to COVID pneumonia. Most of the patients who died had gone into multi-organ failure. Air leak syndromes (pneumothorax and pneumomediastinum) were common findings. 10 patients already had surgical emphysema before taking up for tracheostomy and 6 developed 2-3 days after tracheostomy. The most common complication was bleeding, which was seen in 28 out of 136 patients. The Median weaning of period of patients who survived was 5 days. Conclusion: Performing tracheostomy early in COVID-19 patients helps in early weaning of the patient from the ventilator and makes nursing care easier and increases the availability of ICU beds. The mortality rate was 46% amongst the 136 tracheostomies done in COVID-19 patients. Local site bleeding was the most common complication and surgical emphysema was also seen more than routine tracheostomies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03248-1.

Prevalence of Laryngopharyngeal Reflux Disease in Indian Population.

Laryngopharyngeal Reflux Disease (LPRD) is form of extra-oesophageal reflux due to the backflow of gastric contents into the upper aero digestive tract leading to throat symptoms. World over, the prevalence rate of LPRD, ranges from 5 to 30%. The aim of this study was to find the prevalence rate of LPRD in Indian population. This was an observational study whereby the RSI questionnaire was circulated amongst the population and records collected. All subjects who had RSI score more than 13 were considered to be suffering from LPRD. 2300 responses were collected from almost all strata of population. Out of 2300 people who responded 253 had RSI score > 13, and were considered as suffering from LPRD. Thus the prevalence rate of LPRD in population was 11%. The prevalence rate of LPRD in females was 11.2% and in males was 10.6%. The difference in prevalence among both the genders was not significant.The most common symptom of LPR reported by subjects was heartburn followed by clearing of throat and excess throat mucous. The prevalence of LPRD in Indian population as assessed by RSI score > 13 was 11%. The prevalence is same in males and females.

Effect of Smoking on Nasal Mucociliary Clearance.

Nasal mucociliary clearance (NMC) system is an important defence mechanism in respiratory tract. The contents present in the smoke are found to be toxic to cilia in vitro. Our study aims at evaluating the NMC in smokers so as to know effect of tobacco smoke on ciliary function and also comparing it with non smokers. We also studied effect of duration, intensity and pattern of smoking on the NMC. A total of 60 participants in the age group 21-40 years (30 smokers and 30 non smokers) were included in the study. Saccharin test was performed in all participants. A 0.5 mm diameter particle of saccharin was placed 1 cm from the anterior end of the inferior nasal turbinate. The time duration was noted for the first appearance of sweet taste. The mean NMC in smoker group was 16.53 min and in nonsmoker group was 9.28 min On comparison it was found that NMC time in smoker group was significantly higher than nonsmoker group p < 0.001 also a positive correlation noted between pack years of smoking and NMC. Saccharin test is a simple test to assess NMC. The prolonged NMC in smokers may be due to reduced ciliary activity or due to changes in viscoelastic properties.

Our Experience of Tracheostomy in COVID-19 Patients.

Tracheostomy in patients with COVID-19 requires significant decision making and procedural planning. Use of tracheostomy can facilitate weaning from ventilation and potentially increase the availability of much needed intensive care unit (ICU) beds, however this being a high aerosol generating procedure it does put the health care worker to risk of transmission. Here we present our experience and protocols for performing tracheostomy in COVID-19 positive patients. Eleven tracheostomies were performed in COIVD-19 patients over a period of 2 months (May-June 2020) at this tertiary care hospital dedicated to manage COVID patients. All patients underwent open surgical tracheostomy, the specific indication, preoperative protocols, surgical steps and precautions taken have been discussed. Tracheostomy was done not before 10 days after initiation of mechanical ventilation. Patient's cardiovascular vitals should show recovery with some spontaneous effort. There should be reduction in need for FiO2 and ventilator requirements. Of total 11 tracheostomies performed only one patient had post procedure bleeding which was controlled conservatively. We have summarized our experience in performing tracheostomies in 11 such patients. Our guidelines and recommendations on tracheostomy during the COVID-19 pandemic are presented in this study. We suggest tracheostomies to be done after 10 days of intubation with precautions and given indications with the idea of early weaning off of patient from ventilator and more availability of ICU beds which is already overwhelmed by patient load.

Prevalence of New Onset Anosmia in COVID-19 Patients: Is The Trend Different Between European and Indian Population?

COVID-19 outbreak is major pandemic affecting lakhs of people all across the globe. Along with other nonspecific clinical features, reports mention anosmia to be an important symptom in COVID-19 positive patients. To study the prevalence of anosmia in confirmed COVID-19 patients, in Indian population and to ascertain its significance as a symptom of COVID 19. Study was done at a tertiary care COVID treating hospital. While eliciting detailed history from Covid-19 positive patients, all patients were asked about symptom of anosmia. Same was asked from control group of subjects who were COVID-19 negative. The history of anosmia was also elicited on discharge after the patients tested negative for COVID-19. 74 patients formed part of the study. 11 of 74 (14.8%) patients had anosmia. On using the chi square test for significance the difference was significant (p < .01), suggesting anosmia to be a significant clinical feature in COVID-19 patients. On comparing with world literature it was observed that the prevalence of anosmia is higher in European population as compared to Indian Also the symptom of anosmia improved when the patient recovered from the disease. Prevalence of new onset anosmia in Indian population with COVID-19 is 14.8%. Symptom of anosmia in present times should be considered as a important clinical feature and should raise a suspicion of COVID-19. The prevalence of anosmia in Indian population is much lesser than that reported in European population.

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy.

Voice disorders are common in various laryngeal pathologies. The aim of this study is to evaluate the diagnostic value of videolaryngostroboscopy (VLSS) over videolaryngoscopy (VLS) in laryngeal pathologies. This was a prospective observational study. Detailed examination was carried out for 80 cases which presented with different laryngeal pathologies. Cases were evaluated on the basis of VLS and VLSS in the same sitting and diagnosed separately. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find out the relationship between diagnoses made by VLS and VLSS. The diagnostic value of VLSS is significant; it has 98.15% Sensitivity and 50% specificity over VLS in finding true vocal cord abnormalities. Around one third of the cases, i.e. 26 cases (32.50%) were misdiagnosed on VLS. Also, VLSS gave additional diagnosis in 6 cases (7.50%) which were missed on VLS. However, the diagnoses revealed by VLS and VLSS were same in 48 cases (60%). The diagnostic value of VLSS correlated with the type of laryngeal pathology. Through the present study, it has been deduced that VLSS is the superior modality for diagnosing laryngeal pathologies. It offers better visualisation of the finer aspects of the vocal cords. It has various advantages over VLS in terms of sensitivity and specificity.

Achalasia cardia: an interesting variation as a large neck swelling.

In this report we present a case of large neck swelling that turned out to be achalasia cardia, not a very common presentation of this disease. An elderly female presented with complain of progressive dysphagia, aspiration and regurgitation of food along with right sided neck swelling measuring 10x5 cm. It was associated with weight loss. X-ray chest depicted an unusually large mass in paramediastinal region parallel to right mediastinal border showing central lucencies. A CT scan of neck revealed a gross dilatation of cervical and thoracic oesophagus. Oesophagus enlargement was enormous to the extent that it could be palpated in the neck compressing airway. This presentation of large neck swelling turning out to be a huge dilatation of esophagus on CT, depicts one of the many interesting variations that this condition can present as.

Giant cell tumour of mandible: report of a rare case.

There are various reports of giant cell tumour of long bones but the documented evidence of occurrence of giant cell tumour of mandible is very rare. Because of extreme rarity of occurrence we report one such case. The patient was a 45 year male presented with hard swelling in region of parotid. In CT scan was suggestive of a heterogeneously enhancing lesion lying deep to right parotid gland. It showed central necrosis and erosion of the right coronoid process of mandible. FNAC report was that of giant cell tumour. Tumour was surgically excised preserving the facial nerve and curetting of coronoid process of mandible. He is on follow up till date with no facial palsy and no sign of recurrence.