Frequency-Specific Audit of Audiological Outcomes Following Stapedotomy for Otosclerosis.

Stapedotomy is an effective surgical intervention used for the treatment of conductive hearing loss associated with otosclerosis. The present study aims to quantitatively evaluate the hearing outcomes following primary stapedotomy performed in patients with otosclerosis. It also aims to investigate frequency-specific hearing results of stapedotomy in these patients. This retrospective study enrolled 49 patients with clinical otosclerosis, who underwent primary stapedotomy at a tertiary-care hospital, between January 2014 and December 2019. Pure-tone audiometry (PTA) was performed pre and post-operatively (> 1 year after surgery). Post-operative air conduction (AC) and bone conduction (BC) thresholds were recorded. The primary outcome measure was post-operative air-bone gap (ABG). Low frequency (LF) ABG was calculated as the mean ABG of thresholds at 0.5 and 1 kHz. High frequency (HF) ABG was calculated as the mean ABG of thresholds recorded at 2 and 4 kHz. In all the study patients, the mean post-operative AC and the mean postoperative BC thresholds, showed significant improvement across the tested frequencies of 0.5, 1, 2 and 4 kHz (P < 0.05). The mean post-operative ABG closure was superior at HF, as compared to that at LF (9.54 ± 6.30 dB vs. 12.0 ± 6.63 dB, P = 0.014). A successful surgical outcome (post-operative ABG closure to ≤ 10 dB) was achieved in 61.22% of the study patients. Further, a greater number of patients (71.45%) recorded successful surgical outcome at HF, when compared with those at LF (46.95%, P < 0.05). Favourable hearing outcomes of this study underscore the effectiveness of primary stapedotomy in the treatment of patients with clinical otosclerosis. Better postoperative ABG closure to ≤ 10 dB was recorded at higher frequencies. Further studies assessing post-stapedotomy hearing results at HF are warranted for ensuring better hearing outcomes in the HF range as well. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04126-0.

Comparative Study of Subjective and Objective Analysis in Diagnosis of Obstructive Sleep Apnea.

The gold standard for diagnosis of Obstructive sleep apnea (OSA) is an overnight polysomnography (PSG). However, PSG is time consuming, labour intensive and expensive. In our country PSG is not available everywhere. Therefore, a simple and reliable method of identifying patients of OSA is important for its prompt diagnosis and treatment. This study looks at the efficacy of three questionnaires to serve as a screening test for the diagnosis of OSA in the Indian population. For the first time in India, a prospective study was conducted wherein patients with history of OSA underwent PSG and were asked to fill three questionnaires-Epworth Sleepiness Score (ESS), Berlin Questionnaire (BQ) and Stop Bang Questionnaire (SBQ). The scoring of these questionnaires were compared with the PSG results. SBQ had a high negative predictive value (NPV) and the probability of moderate and severe OSA steadily increases with higher SBQ scores. In comparison, ESS and BQ had low NPV. SBQ is a useful clinical tool to identify patients at high risk of OSA and can facilitate in the diagnosis of unrecognised OSA.

UNHS: A Decade Long Feasibility and Sustenance Study from a Tertiary Care Hospital in India.

Objective The aim of this study is to estimate the incidence of hearing loss in neonates at a tertiary referral center, to assess the associated risk factors in those identified with hearing loss and to explore the challenges of starting and continuing a universal neonatal hearing screening programme in a tertiary care hospital over a decade. Materials and Methods It is a cohort prospective observational study conducted from January 2008 to January 2018. Five thousand five hundred and forty neonates underwent screening for hearing loss, of which 2688 were well babies and 2854 babies had one or more risk factors causing hearing loss. Otoacoustic emissions (OAE) is employed as the first level of screening within one month of birth. Brainstem evoked response audiometry (BERA) is done at 3 months of gestational age for all the well babies who were referred on OAE testing and all the high risk babies irrespective of the result of the OAE screening. The High risk criteria are based on the set criteria by the Joint Committee on Infant Hearing (2007) and American Academy of Pediatrics (1994). Results In our study the incidence of hearing impairment is 5.41 per 1000 neonates screened. In well babies and at risk babies it is 1.49 and 9.11 per 1000 respectively.The common neonatal risk factors associated with hearing loss in our study are babies admitted to neonatal intensive care units (NICU), intrauterine growth retardation (IUGR), birth weight less than 1500 g, respiratory distress syndrome (RDS) and hyperbilirubinemia. Conclusion The incidence of hearing loss in our study is comparable to that reported in literature (Bachmann KR, ArvedsonJC (1998) Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998 May; Vol. 19. No.5. pp. 155-165. http://www.ncbi.nlm.nih.gov/pubmed/9584525 Accessed from May 1998, Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9., Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. (2014) Neonatal hearing screening-experience from a tertiary care hospital in southern India. Indian Pediatr. Vol. 51. No.3. pp 179-183. http://www.ncbi.nlm.nih.gov/pubmed/24277966 Accessed from Mar 2014). Hearing loss is more common in those babies with risk factors as reported in literature (Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9. http://www.ncbi.nlm.nih.gov/pubmed/21654001 Paul AK (2011) Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience. Indian Pediatr. Vol. 48. No. 5. pp 355-359. Accessed from May 2011). Implementation of neonatal hearing screening program at a tertiary care hospital using a two tier system with OAE and BERA is a feasible but challenging service.

Cochlear Implant Surgery During the Covid Pandemic Lockdown-The KEM Hospital, Pune Experience.

In response to the Covid 19 pandemic many governments and professional bodies recommended cancellation of elective surgeries including cochlear implantation. Resumption of elective surgeries was recommended after appropriate permissions were given by the authorities and the hospital had adequate infrastructure in terms of equipment and manpower to start elective surgeries without compromising on patient safety and care. We began cochlear implant surgeries in April 2020. We have done 5 cochlear implants surgeries till date. This manuscript discusses the changes that we did in our preoperative, intraoperative and postoperative protocol.

A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center.

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021-June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

Pediatric synovial sarcoma in the retropharyngeal space: a rare and unusual presentation.

Synovial sarcomas in the head and neck are extremely rare tumors, especially in the pediatric population. 3-5% of synovial sarcomas occur in the head and neck region displaying varied imaging and histopathological features resulting in frequent misdiagnosis. These tumors have a poor prognosis; hence early diagnosis and accurate classification based on imaging, histopathology, and immunohistochemistry are critical for prompt treatment. To the best of our knowledge, imaging findings of pediatric retropharyngeal lipomatous synovial sarcoma have not been reported to date in English medical literature. We report, for the first time, a rare case of retropharyngeal lipomatous synovial sarcoma in a ten-year-old child and discuss the case-specific imaging findings in our patient using magnetic resonance imaging and computed tomography.