Intratympanic Dexamethasone Role in Hearing Protection in Cancer Patients.

Introduction The study aims to determine the role of intratympanic dexamethasone (ITD) on the hearing profile of patients with head and neck cancer post-chemoradiotherapy. Study design This study employs a prospective case-control design. Subjects and methods In total 834 patients were evaluated for eligibility. Seven hundred and eleven were excluded because they didn't meet the inclusion criteria. A hundred cases out of 123 were diagnosed with head and neck cancer for which the treatment protocol included cisplatin concurrent to radiotherapy recruited. Before each cisplatin treatment session, ITD was injected into one ear (experimental ear) while the other ear of the same patient served as the control. Pure-tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE) test results of the baseline and follow-up examinations in the sixth and 12th weeks were compared within and between the study and control ears. Results For pure tone thresholds, significant hearing threshold change was noticed at 8 kHz in the experimental group at six weeks and at ≥ 6 kHz in the control group. At 12 weeks, high frequencies were significantly affected at ≥ 4 kHz in the control group. When the baseline was compared across the groups in the 12th week, for otoacoustic emissions, high frequencies showed a loss in the control group more compared to the experimental side (Wilcoxon signed-rank test). Conclusion ITD functions less effectively at higher frequencies because the basal turn of the cochlea is more susceptible to cisplatin ototoxicity. ITD might have potential in the reduction of cisplatin-induced hearing loss.

Impact of Thyroid surgery on Voice: A prospective study.

Thyroidectomy is one of the most common neck surgery done worldwide. It is associated with debilitating post-operative voice changes even without recurrent laryngeal nerve (RLN) injury. Aims and Objectives: To study the impact of thyroidectomy on voice parameters in the absence of Recurrent Laryngeal Nerve and External Branch of Superior Laryngeal Nerve injury and comparison between the pre and post-operative changes in the subjective and objective voice parameters. Methodology: Patients fulfilling the inclusion criteria underwent thyroidectomy. The Subjective voice assessment was done using Voice Impairment Score (VIS) and objective parameters were analyzed using Multi-Dimensional Voice Program (MDVP) pre-operatively and post-operatively at 1 week, 1 month and 3 months interval. Results: On MDVP analysis of patients, a fall in Mean F0 (Hz), Minimum F0 (Hz) and Maximum F0 (Hz) values was noted at 1 week after surgery. But a trend toward the pre-operative values was observed at 3 months post-operatively.

Changes in Voice After Septoplasty: A Pilot Study.

The aim of this study was to evaluate changes in voice after septoplasty in adults using the Dr.Speech assessment module in conjunction with subjective evaluation using Voice Handicap Index (VHI). A total of 50 consecutive patients with symptomatic Deviated Nasal Septum (DNS) undergoing septoplasty were included in the study. Patients fit for surgery underwent septoplasty by standard technique. Voice assessment was done by subjective voice evaluation and Acoustic voice analysis preoperatively, 1 week after surgery and 1 month after surgery. Mean values of both males and females for Fundamental frequency (F0) were within the normal range at all the three times of assessment. No- significant differences were obtained at all the three times of assessment in males and females respectively. Significant results were obtained while comparing the preoperative and postoperative SNR dB values. Mean VHI score at preoperative, 1 week postoperative and 1 month postoperative was 23.2, 22 and 21.5 respectively. No statistical difference was obtained while comparing the mean VHI score at different time intervals. The scores between 0 and 30 are in the mild category, i.e. minimal amount of handicap. The scores of all the patients were less than 30 at all times of assessment. To conclude, post-operative changes in the voice parameters were minimal and not significant, they were indicative of greater acoustical quality of voice and lesser nasalized speech, thus reflecting the positive outcome of surgery.

Nasoethmoidal Schwannoma as a Mimicar of Esthesioneuroblastoma: A Case Report and Literature Review.

Nasoethmoidal schwannomas are rare lesions and their presentation with intracranial extension is even rarer. Here, a patient presenting with rhinorrhea, epistaxis, and proptosis of left eye was diagnosed with giant nasoethmoidal schwannoma extending to frontal lobe and orbit, which was managed with bifrontal craniotomy with endoscopic transnasal gross total excision. This being predominantly a benign lesion has good prognosis if total excision is achieved.

Clinicoradiological profile and outcome of cavernous sinus syndrome with coronavirus disease-2019-associated rhino-orbito-cerebral mucormycosis.

Objective: With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along with comparative analysis of CSS negative COVID-19-associated ROCM. Material and Method: This was a prospective and observational study conducted from May 1, 2021, to July 31, 2021. Subjects included ROCM with active or recovered COVID-19 (past 6 weeks) and were categorized and staged. CSS was defined as involvement of two or more of third, fourth, fifth, or sixth cranial nerve with one each direct and indirect qualitative neuroradiological features. Clinicoradiological features of CSS-positive and negative COVID-19-associated ROCM groups were compared. Results: Incidence of CSS with COVID-19-associated ROCM was 28%. Mean age of subjects was 44 ± 15 years with 60% being males and 73% were proven ROCM. Significant differences seen across the CSS-positive and negative groups were ocular, nasal, and cerebral findings including eyelid and periocular discoloration, ptosis, proptosis, ophthalmoplegia, nasal discharge, mucosal inflammation, and fever. Oculomotor, trochlear, and abducens nerves were significantly involved more in CSS-positive group. Significant radiological findings across two groups included indirect features in orbit, nose, and paranasal sinuses along with direct features in cavernous sinus. Surgical intervention was more common in CSS-positive group. Mortality in CSS-positive group at 8-24 weeks was 13 and 27%, respectively. Conclusion: Extension of ROCM to CSS was more common in young males in advanced stages of proven ROCM with concurrent COVID-19. CSS-positive group had significant difference in clinicoradiological features involving orbit, nose, paranasal sinuses, and central nervous system as compared to CSS-negative group. This study highlights the need to develop an objective scoring system considering clinical and radiological features for diagnosis of CSS with COVID-19-associated ROCM.

Prevalence of Otitis Media with Effusion in Children with Hearing Loss.

Otitis media is an inflammation of the middle ear cleft, with or without intact tympanic membrane. Otitis media is known to be one of the most common childhood infections. Middle ear effusions have been recognized to grab increasing attention because of the problems they pose in both the diagnosis and the treatment, and because of the fear that effusion is the cause of learning difficulties, irreversible middle ear disease, or both. To study prevalence of otitis media with effusion in children with hearing loss. Materials and methods: This prospective study was conducted on children with hearing loss ageing between 3 and 15 years presenting to ENT OPD of GURU GOBIND SINGH MEDICAL COLLEGE FARIDKOT with complaint of hearing loss from January 2015 to June 2016. Total of 125 children were taken in study. Detailed history and complete ENT examination was done along with pure tone audiometery and impedence audiometery. Most common complaints of patient were otalgia on ototscopic examination majority of patients had congested tympanic membranes. Otitis media with effusion was most common cause of hearing loss. Majority of children diagnosed with otitis media with effusion were in age group of 6-8 years of age. Patients with mild hearing loss due to otitis media with effusion, on pure tone audiometery was more as compared to moderate hearing loss. B type of tympanogram was found in majority of cases. The potential of otitis media with effusion to cause a series of sequels and complications such as tympanosclerosis, retraction pockets, adhesive otitis media and hearing or speech impairment makes the disease an important public health problem. To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of otitis media with effusion.

Spontaneous pneumomediastinum with pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis: A rare association.

Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax and epidural pneumotosis. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis in an 18-year-old gentleman in the absence of identifiable cause.

Prospective study of 'otological injury secondary to head trauma'.

The aim of study was to evaluate etiological factors, types of skull fracture and associated hearing loss in 50 cases of head injury. This was prospective study involving 50 cases of head injury. Each patient will be subjected to detailed history, otological and neuro otological examination, radiological study followed by audiological assessment by pure tone audiometry. Road traffic injuries were the most frequent cause of injuries in our patients comprising 64% of the total, personal accidents/domestic falls, assaults and agriculture and related injuries were responsible for 8% of the total injuries each. Other causes of the injuries were sports injuries (6%), industrial accidents (4%) and fire arm injuries (2%). Out of the 9 patients having temporal bone fracture 7 cases (78%) had longitudinal fracture and 2 cases (22%) had transverse fracture. Out of the 21 patients having hearing loss, 5 patients (23.8%) had conductive hearing loss, 9 patients (42.86%) had mixed hearing loss and 7 patients (33.34%) had sensorineural hearing loss. Facial nerve palsy was present in 2 patients (28%) among longitudinal fracture cases and 1 patient (50%) among transverse fracture cases. Motor Vehicular accident (MVA) are still the commonest cause of injuries compared to the other mode of injury. Patients with longitudinal fracture showed conductive and mixed loss and patients with transverse fracture showed sensorineural hearing loss. Incidence of facial nerve paralysis was more with transverse fracture cases than with longitudinal fracture cases.