Is there fungal infestation in paediatric chronic otitis media - Mucosal disease?

OBJECTIVES: To determine the prevalence of fungal infestation in paediatric chronic otitis media (COM)-mucosal disease and to study the various factors that might influence the said infestation. METHODS: A cross-sectional study was done on the cited subject in a sample size of 66 paediatric patients [Age group: 1-18 years] suffering from active COM-mucosal disease. In all we had 75 ears from which swab samples were taken as some patients had bilateral disease. Clinical record was documented in each case. Three sample swabs were analysed for aerobic, anaerobic and fungal infection respectively from the discharging ear. Fungal infection was diagnosed by culture. The data was tabulated and statistically analysed for any correlation of fungal infestation with age, sex, background, duration of COM, previous antibiotic/steroid usage and intractable otorrhoea. RESULTS: We recorded a prevalence of 32% for fungal colonization of COM-mucosal disease in paediatric population i.e., 24 out of 75 ears. There was no association observed between fungal infestation and specific paediatric age group, sex, background or duration of the disease. However, a distinct statistical correlation was present between fungal infestation and previous antibiotic/steroid usage and intractable otorrhoea. CONCLUSION: Findings of this study lead us to conclude that all cases of paediatric COM-mucosal disease should be analysed for fungal colonization, especially those with intractable otorrhoea and there should be judicious use of antibiotics and steroid ear drops in COM-mucosal disease.

The role of sinus CT in surgical treatment decisions for chronic rhinosinusitis.

AIMS & OBJECTIVES: To define a predictive role of Lund Mackay CT scan [LM] score in treatment of chronic rhinosinusitis [CRS] by functional endoscopic sinus surgery [FESS]. MATERIALS & METHODS: A prospective study was done on the cited subject in a sample size of 30 patients suffering from CRS failing maximal medical treatment. All the patients underwent FESS under general anaesthesia. CT scan with Lund Mackey scoring was done preoperatively and postoperatively. The symptomatic improvement was analysed using SNOT-22 score over a time period of one year. The SNOT-22 scores were statistically analysed with pre-op Lund Mackey scores to draw judicious conclusions. RESULTS: A mean Lund Mackey pre-operative score [LM] of 13.1 was recorded in the patients undergoing FESS for CRS. Further, the patients were divided into two groups: one with LM score less than 13.1 [Group-A] and the other with LM score of more than 13.1 [Group B]. A statistically significant improvement in symptoms with good long-term prognosis was recorded in Group-B only. In addition, a direct correlation between Lund Mackay score and extent of surgery was also seen, greater the score more extensive the FESS. CONCLUSION: There is a predictive value of LM score in prognosis of FESS. We believe that a minimum LM score of 13.1 gives good clinical outcomes in patients with CRS who undergo FESS and thus can be used as a threshold for recruiting CRS patients for FESS.

Circumferential Subannular Tympanoplasty: Panacea for revision tympanoplasty.

OBJECTIVE: To evaluate the role of Circumferential Subannular Tympanoplasty [CST] in cases of Revision tympanoplasty. METHODS: A retrospective statistical analysis of data of 81 patients who underwent revision tympanoplasty with CST technique [essentially Type I tympanoplasty] was done. An intact graft at the end of 6 months was regarded as a surgical success. RESULTS: Overall, we recorded a surgical success rate of 97.5% [79 out of 81 cases] with a 100% surgical success for anterior perforations. There was no impact of size or site of perforation on the outcomes of revision tympanoplasty by this technique. In addition, a statistically significant hearing improvement was recorded in the study. The mean pre-operative and post-operative ABG were 33.85 dB and 18.87 dB respectively. The mean ABG closure was 14.89 dB. The value of "p" by Chi square test was found to <.05. CONCLUSION: CST is an excellent technique for revision tympanoplasty and seems to address the shortcomings of conventional onlay and inlay techniques.

Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method.

PURPOSE: To diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy. MATERIALS AND METHODS: Endoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS. RESULTS: RGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values. CONCLUSION: Image analysis is an easy, economical and objective method to diagnose LPR.

Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study.

AIMS & OBJECTIVES: To detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance. STUDY DESIGN: Prospective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital. MATERIALS & METHODS: Forty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed. RESULTS: Out of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established. CONCLUSIONS: There is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.

Extended high frequency audiometry in users of personal listening devices.

PURPOSE: Noise exposure leads to high frequency hearing loss. Use of Personal Listening Devices may lead to decline in high frequency hearing sensitivity because of prolonged exposure to these devices at high volume. This study explores the changes in hearing thresholds by Extended High Frequency audiometry in users of personal listening devices. MATERIAL AND METHOD: A descriptive, hospital based observational study was performed with total 100 subjects in age group of 15-30years. Subjects were divided in two groups consisting of 30 subjects (Group A) with no history of Personal Listening Devices use and (Group B) having 70 subjects with history of use of Personal Listening Devices. Conventional pure tone audiometry with extended high frequency audiometry was performed in all the subjects. RESULT: Significant differences in hearing thresholds of Personal Listening Device users were seen at high frequencies (3kHz, 4kHz and 6kHz) and extended high frequencies (9kHz, 10kHz, 11kHz, 13kHz, 14kHz, 15kHz and 16kHz) with p value <0.05. Elevated hearing thresholds were observed in personal listening devices users which were directly proportional to volume and duration of usage. CONCLUSION: In present study no significant changes were noted in hearing thresholds in PLD users before 5years of PLD use. However, hearing thresholds were significantly increased at 3kHz, 10kHz, 13kHz in PLD users having >5years usage at high volume. Thus, it can be reasonably concluded that extended high frequencies can be used for early detection of NIHL in PLD users.

A rare case of lithium battery ingestion in a neonate with no complications.

We report an extremely rare case of homicidal lithium battery ingestion in a neonate hitherto unreported in the medical literature. Although a definitive diagnosis was initially missed in the baby, the patient survived with no complications whatsoever even after retention of the said foreign body for 10 days.

Can Pregnancy Lead to Changes in Hearing Threshold?

PURPOSE: This study explores the changes in hearing thresholds in pregnancy. MATERIALS AND METHODS: A prospective hospital-based observational study was performed with a total of 69 patients in the age-group of 18 to 40 years. Patients underwent hearing assessment twice during the study period. Conventional pure tone audiometry and impedance audiometry were performed, first during the antepartum period (28-32 weeks of gestational age) and second time during the postpartum period (6 weeks postpartum). RESULTS: Significant difference was seen between the average of air conduction threshold values at speech frequencies when antepartum values were compared with postpartum values. CONCLUSION: The alterations in hearing sensitivity in pregnant females which improved during the postpartum period can be attributed to pregnancy.

The Role of Biofilms in Chronic Otitis Media-Active Squamosal Disease: An Evaluative Study.

OBJECTIVES: To study the presence of biofilms in patients of chronic otitis media (COM)-active squamosal disease and to evaluate the microflora and clinical impact of biofilms. METHODS: A total of 35 patients suffering from COM - active squamosal disease was studied. Cholesteatoma sample was collected at the time of mastoid surgery and the same was used to image for biofilms by scanning electron microscope. The said sample was also analyzed microbiologically. RESULTS: Biofilms were present in 25 (72%) patients including 6 cases of fungal biofilms (24%). Biofilms were detected irrespective of the micro-organism growth. No statistically significant relationship was observed between biofilms and discharging ear and complications of COM. Though univariate analysis of our data found some correlation between duration of disease, the extent of cholesteatoma and ossicular necrosis but multivariate analysis revealed no such associations, thereby implying a doubtful association between these factors and biofilm. CONCLUSIONS: Biofilms are an integral part of cholesteatoma ear disease and sometimes harbors fungal isolates.

Evaluation of Type III Tympanoplasty Using Cartilage Ossiculoplasty in Cholesteatoma Ear Surgery.

This prospective observational study evaluates the role of tympanoplasty type III in cholesteatoma ear disease during same sitting with mastoid surgery using cartilage ossiculoplasty. Forty patients of chronic suppurative otitis media-cholesteatoma disease were recruited in the study. All the patients had extensive cholesteatoma and underwent canal wall down mastoid surgery. Tympanoplasty type III, that is, stapes columella, minor columella, or major columella, was done in each case along with mastoid surgery depending upon the remnant ossicular status. Conchal cartilage graft was used for ossiculoplasty along with temporalis fascia graft. Hearing and graft uptake results were evaluated at the end of 6 months postoperatively. Of the 40 cases, 3 cases failed tympanoplasty. In the remaining 37 cases, a statistically significant hearing improvement (air-bone gap of 33 dB) was observed postoperatively. Seven cases underwent stapes columella, 13 cases underwent minor columella, and 17 cases underwent major columella tympanoplasty type III. Although a hearing improvement was recorded in all these subgroups, a statistically significant hearing gain was present only in tympanoplasty type III minor columella cases thereby underlying the importance of intact stapes. However, it is difficult to discern the type of tympanoplasty type III that the patient would undergo prior to the ear surgery.

The role of Helicobacter Pylori and laryngopharyngeal reflux in recurrent tonsillitis.

OBJECTIVES: To detect Helicobacter Pylori [HP] in tonsillar tissue of recurrent tonsillitis cases and assess the possible role of Laryngopharyngeal reflux [LPR] in tonsillar HP infection. METHODS: A prospective study was done on the cited subject in a sample size of 50 paediatric patients [Age group: 6-18 years] suffering from recurrent tonsillitis. LPR was diagnosed by Reflux Symptom index [RSI] and Reflux Finding score [RFS]. A score of more than 7 and 13 was regarded as significant for RFS and RSI respectively. Patients with both scores significant were regarded to be suffering from LPR. Tonsillar specimen after tonsillectomy were subjected to urease test, histopathology [ Modified Giemsa Staining] and culture to detect HP. A minimum of two positive tests of the mentioned three were taken as gold standard to diagnose colonization of HP. Tabulated data was statistically analysed. RESULTS: We recorded an incidence of 9% [18 cases] for LPR in recurrent tonsillitis. No case of HP colonization of tonsils was detected in this case series, even in patients of LPR. CONCLUSION: We conclude that tonsils are not an extra gastric reservoir of HP. In addition, there is no aetiological relationship between recurrent tonsillitis and HP. And lastly, LPR is not a significant factor for colonization of tonsils by HP.

Predictors of nature of ingested foreign bodies in children & assessment of operative outcomes.

OBJECTIVE: To examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB). METHODS: Retrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed. RESULTS: Cases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p < 0.001). Average duration of ingestion: 37/9.5 h (p < 0.001). Patients below 3: 31.3/62.8% (p < 0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p < 0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p = 0.02). LBBFB group: Successful removal in 1st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months. CONCLUSIONS: Children <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.

Cytomorphological Differences between Liquid-Based Cytology and Conventional Smears in Fine-Needle Aspirates of Thyroid Lesions.

BACKGROUND: Liquid-based cytology (LBC) is becoming an independent processing modality for cytology specimens. Decreased obscuration, single-slide examination, lesser screening time, and potential application of ancillary techniques are the various advantages it offers. AIM: To study and compare the cytological features of fine-needle aspirates from thyroid swellings on LBC with conventional smears (CS). MATERIALS AND METHODS: Fine-needle aspiration was performed on 150 patients with thyroid nodule. The aspirate was first used to prepare a minimum of two CS and the remaining aspirate was used to prepare one SurePath smear. The final diagnosis was given according to the Bethesda system for reporting thyroid cytopathology (2007). Cytomorphological parameters were semi-quantitatively scored. Pearson's Chi-square test was used and P value was calculated. A P value <0.05 was considered significant. Cytohistological correlation was done wherever possible. RESULTS: LBC showed higher nondiagnostic rate than CS. Significant cytomorphological differences on LBC included: (i) higher frequency of single, naked nuclei; (ii) lesser nuclear and cytoplasmic details; (iii) decreased colloid which appeared differently (as napkin fold and dense droplet); (iv) increased cyst macrophages; and (v) decreased obscuration by blood. CONCLUSION: LBC can supplement CS but cannot replace it.

Status of Otorhinolaryngology as Specialty of Choice Among Female Medical Graduates.

Specialty choices among medical graduates have undergone changes over time. We aimed to analyze status of otorhinolaryngology as specialty of choice among female medical graduates and factors affecting it. A total of 123 female medical graduates were surveyed during their internship over a period of 1 year in a tertiary-care hospital. Each intern was assessed using a questionnaire at the end of otorhinolaryngology rotation. The survey included nine questions about future career choices with special focus on ENT as a choice for specialization. Questions on choice of specialty, reason for choice, quality of undergraduate teaching and clinical postings were included. The post graduation specialty choices in descending order are Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dermatology, Ophthalmology, Radiology, ENT, Anesthesia, Psychiatry followed by Physiology, Anatomy and Biochemistry. Among surgical branches most popular choice was General Surgery followed by Obstetrics and Gynecology, Ophthalmology, ENT and Orthopedics in descending order. Reason for the choice included advice from family and friends. Forty two interns (34.2%) followed advice of senior colleagues, 42 (34.2%) followed advice of relatives in the medical field, 25 (20.3%) took advice of non-medico parents while 14 (11.3%) followed their peer group. Regarding the opinion on the quality of undergraduate teaching and clinical postings, both were rated good by the majority. Otorhinolaryngology is less preferred than other general surgery, Obstetrics and Gynecology and ophthalmology by female medical graduates among surgical disciplines. Possible reasons and ways to improve status of Otorhinolaryngology are discussed.

Septic Lateral Sinus Thrombosis: Sinus Exploration Is Unnecessary.

The algorithm of treatment of septic lateral sinus thrombosis (SLST) has undergone a paradigm shift with the understanding of the natural history of sigmoid sinus thrombosis. Thus, the recent medical literature promulgates the management of these cases with no sinus exploration. However, in view of marked paucity of literature on the cited subject, not much is known about this form of treatment. We present our experience of treating two paediatric cases of SLST with mastoid surgery and no sinus exploration: both cases had excellent recovery. Finally, conclusions are drawn in light of contemporary literature on this subject.