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1.
Indian J Otolaryngol Head Neck Surg ; 76(5): 4974-4978, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39376374

RESUMEN

PPS space tumors are extremely rare, accounting for 0.5% of head and neck neoplasms. Trans-oral, Trans-cervical, Trans-parotid, Trans-cervical-trans-mandibular, and infratemporal are various surgical approaches that have been described for PPS tumors. Of late, with the advent of robotic surgery, Trans Oral Robotic Surgery (TORS) for PPS tumors is being increasingly advocated with promising results. To establish both efficacy and safety of Trans Oral Robotic Surgery, Five cases of pleomorphic adenoma of parapharyngeal space with sizes varying between 2.5 cm to 7.5 cm were evaluated and removed using Trans oral robotic approach using the Da Vinci system. Three were removed in toto and two in piecemeal fashion. There was capsule breach in 2 cases, no major complication was reported in any of the cases. Transoral Robotic Approach for PPS tumors can provide the much-required bridge between Transcervical and Trans mandibular Oral Approach. It provides a better direct approach. Carefully selected patients with well encapsulated tumors are more amenable to this approach.

2.
J Maxillofac Oral Surg ; 23(5): 1057-1062, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39376758

RESUMEN

Background: Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life. Objective: The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients. Methodology: Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale. Results: The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration. Conclusion: We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.

3.
J Maxillofac Oral Surg ; 23(5): 1079-1088, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39376770

RESUMEN

Background: Oral cancer is the most prominent cancer subtype among all head and neck cancers, the incidence and prevalence of which has been consistently increasing in past years around the globe. At advanced stages, oral cancer imparts significant mortality, morbidity, and mutilation among the patients, and therefore, diagnosis and treatment of the disease at early stages are considered the optimum strategy for the management of the disease. Since molecular changes appear earlier than physical symptoms, several molecular biomarkers are currently being investigated for their role in diagnosing and treating disease. MMP-9 belongs to the family of proteinases that are involved in cytoskeletal degradation, which is a crucial phase of cancer progression. Objective: In the present study, we analyzed the serum concentration of MMP-9 in oral cancer patients and tried to establish MMP-9 as a predictive biomarker for the progression of oral cancer. We also correlated the clinical, sociodemographic and biochemical parameters with the serum concentration of MMP-9 in oral cancer patients. Methods: Serum was extracted from the blood sample of 38 oral cancer patients and was analyzed for the concentration of MMP-9 using sandwiched ELISA. Predesigned proforma was used to capture the clinical, sociodemographic and biochemical parameters. Unpaired t-test was used to compare two means, one way ANOVA was used to compare more than two means and Pearson's correlation was used to correlate the variables. Results: The mean concentration of MMP-9 in patients of oral cancer was 816.9 ± 236.1 ng/mL. The MMP-9 expression level was higher at advanced oral cancer stages than in the early stages. No significant difference in the MMP expression was found in terms of sociodemographic risk factor and tumor site. MMP-9 exhibit significant negative correlation with the HDL and significantly positive correlation with the PTI. Rest of the biochemical parameters does not exhibit significant correlation. Conclusion: The present study suggests that serum concentration of MMP-9 can be a predictive biomarker for the progression of oral cancer, which needs to be validated by performing further longitudinal cross-sectional studies by taking ample sample size.

5.
Indian J Otolaryngol Head Neck Surg ; 76(4): 3133-3139, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39130254

RESUMEN

To assess the exact role of high-risk HPV testing in patients of carcinoma unknown primary with secondary metastasis to the neck who underwent TORS and neck dissection for identification of the primary site. A prospective study was carried out at a tertiary care centre over one year. Patients with unilateral neck swelling, which was cytologically proven squamous cell carcinoma neck metastasis, were included in the study. After clinicopathological evaluation, they underwent TORS-assisted ipsilateral radical tonsillectomy, tongue base mucosal wedge biopsy for primary site identification, and ipsilateral neck dissection. They underwent HPV RNA ISH from the tonsil, the base of the tongue and blood. They also underwent HPV DNA testing from the blood. P16 was done in the base of tongue, tonsil, and lymph node specimens. In the study cohort of 18 patients who underwent ipsilateral radical tonsillectomy, mucosal tongue base wedge biopsy and neck dissection, p16 positivity was isolated in 5.56%, 0% and 2.78% of patients, respectively. (n = 1/18, 0/18, 5/18). Interestingly, HPV E7 mRNA expression was absent in the tonsil /base of tongue specimens, but metastatic lymph nodes displayed expression in 11.11%. HPV DNA was undetected in all analysed tissues and patients' blood. In the Indian subcontinent, it is not essential to do detailed high-risk HPV analysis in cases of carcinoma unknown primary with secondary metastasis to the neck.

6.
Indian J Otolaryngol Head Neck Surg ; 76(4): 3081-3087, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39130274

RESUMEN

BACKGROUND: The digit in the noise test is a simple hearing screening tool that can identify hearing loss at the early stage. This screening tool takes less time than traditional pure-tone audiometry. There is a scarcity of hearing health professionals with few resources for carrying out hearing screening on a large scale in India. Hence, a hearing screening tool for the Hindi-speaking population is needed. AIM AND OBJECTIVE: The study aimed to develop and validate the Digit in Noise test in Hindi (DIN-H). METHODS: A native Hindi female speaker recorded single digits from 1 to 9 made into triplet combinations, which were binaurally presented to 20 normal hearing subjects having hearing thresholds less than 25 dBHL from 250 to 8000 Hz in the presence of broadband speech-shaped noise. The digit triplets were homogenized using speech intelligibility function for similar difficulty levels across stimuli. The homogenized stimuli were evaluated by obtaining the Speech Recognition Threshold (SRT) of 20 normal hearing subjects. RESULTS: The Mean SRT was - 10.4 and - 11.3 dB before and after homogenization. A strong positive correlation existed between test and retest SRTs (0.78). Mean SRT and slope obtained before and after optimization were comparable to other languages like Korean and English. This test can act as a reliable screening tool for assessing individuals. The test was administered to 106 normal hearing participants. The 95th percentile of the SRT value obtained was - 5.6 dB, which was kept as a cut-off score for the screening test. CONCLUSION: DIN-H can be used as a screening tool for assessing the integrity of the auditory system on a large scale in less time for the Hindi-speaking population.

8.
Mycoses ; 67(5): e13745, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38767273

RESUMEN

BACKGROUND: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse. OBJECTIVES: To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis). METHODS: We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM. RESULTS: We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors. CONCLUSION: Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.


Asunto(s)
COVID-19 , Coinfección , Mucormicosis , Humanos , COVID-19/complicaciones , COVID-19/mortalidad , Mucormicosis/mortalidad , Mucormicosis/epidemiología , Mucormicosis/complicaciones , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Prevalencia , Coinfección/mortalidad , Coinfección/epidemiología , Coinfección/microbiología , India/epidemiología , Adulto , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/mortalidad , Aspergilosis Pulmonar/epidemiología , SARS-CoV-2 , Anciano , Estudios de Casos y Controles , Enfermedades Pulmonares Fúngicas/mortalidad , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/epidemiología
9.
Indian J Otolaryngol Head Neck Surg ; 76(2): 1509-1515, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38566680

RESUMEN

Meniere's Disease is a rare ear disorder that can cause severe morbidity to the patient and has no definitive treatment to date. Endolymphatic hydrops is the critical event. Though symptomatology is well understood, the exact etiology of Endolymphatic hydrops attack is still unclear. Twenty-five consecutive patients of Meniere's Disease diagnosed in the Vertigo clinic aged 12 to 70 years were included. Their allergic status was evaluated using a skin prick test. Allergic and non-allergic patients were then identified. Comparison between the two groups was made to identify the effect of allergy on the severity of symptoms using vertigo scales, Functional level scale, Dizziness handicap index, and Pure tone average staging. The prevalence of allergy among Meniere's Disease patients was 56%. The most common allergen found in our study was tyrophagus(n = 8). Polysensitization was more common(n = 12). Airborne allergens were more common than food allergens. There was no significant relationship between the severity scales and the allergen positivity status (p > 0.05). The prevalence of allergy is more among patients with Meniere's Disease. The Endolymphatic sac is allergy prone. The occurrence of endolymphatic hydrops may be due to a cross-reaction of allergen-induced IgE antibodies to self-antigen. Management of the specific allergen may help decrease symptomatology in these patients. Allergen-specific therapies have a promising role in the treatment of allergic conditions and provide a long-term symptom-free period in affected individuals. This can be applied in patients with Meniere's Disease having associated allergic features based on their skin prick test results.

10.
Indian J Otolaryngol Head Neck Surg ; 76(2): 1716-1723, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38566707

RESUMEN

Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04389-7.

11.
Indian J Otolaryngol Head Neck Surg ; 76(2): 1941-1948, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38566719

RESUMEN

The detection of the primary site in Carcinoma of Unknown Primary (CUP) is a challenging task which can significantly alter the course of management and also prognosis. Various modalities have been assessed with varying sensitivity and specificity. Imaging and cytological diagnosis have formed a key part of the diagnostic algorithm of CUP. Trans Oral Robotic Surgery offers the advantage of being both diagnostic as well as therapeutic with promising sensitivity and specificity and can form an integral part in the management of CUP. A prospective study was carried out at a tertiary care centre over a period of one year. Patients with unilateral neck swelling which was histopathologically proven squamous cell carcinoma neck metastasis were included in the study. They were evaluated with endoscopy and radiology according to the standard algorithm. When these failed to detect the primary, the patients underwent ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy via TORS. Post-operative histopathological examination was done on the resected specimens to detect the primary site. Transoral Robotic Surgery was able to localise primary in 50% of the patients enrolled in the study. Out of the primary site identified by TORS; 55.56% were located in the tonsil and 44.4% in the tongue base. TORS can offer promising detection rates of the occult primary in CUP and should form an integral part of the diagnostic algorithm.

12.
Indian J Otolaryngol Head Neck Surg ; 76(2): 2166-2170, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38566724

RESUMEN

Perioperative high dose rate brachytherapy involves insertion of brachytherapy catheter over the tumor bed during surgical removal of disease followed by radiation in the postoperative period. It has applications in radiotherapy dose escalation or reirradiation and for extending the surgical margins. We report here initial results of treatment in five cases of locally advanced head and neck cancers.

14.
J Maxillofac Oral Surg ; 23(1): 16-22, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38312965

RESUMEN

Background: Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life. Objectives: Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer. Methods: In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed. Results: Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched. Conclusion: Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.

15.
Clin Microbiol Infect ; 30(3): 368-374, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38081413

RESUMEN

OBJECTIVES: To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM. METHODS: We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality. RESULTS: We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival. DISCUSSION: CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.


Asunto(s)
Aspergilosis , COVID-19 , Coinfección , Mucormicosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Estudios Retrospectivos , Estudios de Cohortes , Glucocorticoides , COVID-19/complicaciones , COVID-19/terapia , Factores de Riesgo , India/epidemiología , Hipoxia/complicaciones
16.
Indian J Otolaryngol Head Neck Surg ; 75(4): 3031-3038, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37974745

RESUMEN

Parental involvement in the rehabilitation process is one of the critical factors for the success of cochlear implants in their wards. Skills to use a cochlear implant (CI) device appropriately and manipulate the different settings are essential to gain maximum benefits. There was a need to have a tool in Hindi to assess the skills of parents to manage the CI device. The study was conducted with the following aims: To translate and adapt Self-administered Cochlear Implant Management Skills (CIMSSelf) into the Hindi language. To find an association between the CI management skills of parents and outcomes in their implanted wards. To compare pre-post retraining scores on CIMS-self in Hindi (HN) and to find out factors affecting the scores. CIMS-self (English) was translated into Hindi using the forward and backward translation method. CIMS-self (HN) was administered to 22 parents of cochlear implanted children to evaluate their CI device management skills in the pretraining phase. The questionnaire was re-administered between 2 and 4 weeks to check the reliability. The outcome of CI in the children was assessed using the test tools viz. Categories of Auditory Perception, Integrated Scales of Development, Speech Intelligibility Rating, and Meaningful Auditory Integration Scale (MAIS). Subjects with less than 100% score received retraining on CI device management skills. CIMS-self (HN) was readministered two weeks after completing training, and results were compared between pre-post training sessions. There was no significant correlation between CIMS-self (HN) scores and demographic of the parents and their implanted wards, CI device factors, and clinical outcomes. A significant correlation was found between the CIMS-self (HN) and MAIS scores (p < .05). The Cronbach's alpha for test-retest reliability of the CIMS-self (HN) survey was 0.998. Participants showed a significant improvement in CIMS-self (HN) scores following the intervention, demonstrating that the CIMS-self (HN) is sensitive enough to detect changes in CI device management following retraining. A client who self-reports difficulty may benefit from consultation if it helps to improve their confidence in CI device management. The CIMS-self (HN) survey can be used to evaluate and re-evaluate CI device management skills at regular intervals and may save clinical time.

17.
Int. arch. otorhinolaryngol. (Impr.) ; 27(3): 407-411, Jul.-Sept. 2023. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1514248

RESUMEN

Abstract Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

18.
Int Arch Otorhinolaryngol ; 27(3): e407-e411, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37564478

RESUMEN

Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypotympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.

19.
Int J Pediatr Otorhinolaryngol ; 172: 111695, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37567086

RESUMEN

OBJECTIVES: The objectives of the present study were to understand the parental views regarding stress, and its affect language, and auditory outcomes. The study also aims to understand the relationship between parental stress, and child's age. DESIGN, SETTING AND PARTICIPANTS: A retrospective study was performed at a tertiary medical hospital. 50 parents of cochlear implant recipients were recruited for the study. The parents were interviewed and the children were tested using a test battery. The average age of implantation was 4.29 years, and the average hearing age was 3.23 years. MAIN OUTCOME MEASURES: The parents were interviewed about their child's needs, and experience with the cochlear implant using the Strength, and Difficulty questionnaire in Hindi, Questionnaire on Resources, and Stress-Short Form, and the Family Environment Scale, Closed - format Questionnaire to understand parental views, and experiences. The language outcomes were studied using the Integrated Scales of Development (ISD), Revised Categories of Auditory Performance. Factor analysis, and Chi-square tests were performed to understand potential relationships between parental stress, and child language, and/or auditory outcomes. RESULTS: The results provide five main factors that accounted for significant variance including financial stress (30.1%), hyperactivity (15.2%), lack of personal rewards (13%), peer problems (10.9%), and emotional problems (9.2%). Acquisition of language was highly influenced by stress and caregiver's 'lack of personal rewards. 'Financial stress', and 'hyperactive behavior' of the child significantly affected the receptive language acquisition of a HI child. The most concerning factors for parents were well-being, and happiness (0.885), followed by social relationships (0.830), communication (0.736), the process of implantation (0.695), and the decision to implant (0.681). The stress regarding finance among parents increased marginally (0.024) as the child's age progressed. CONCLUSION: Parental stress is ongoing. The impact on the expressive language development of the child is significant. The maximum concern of parents is regarding the financial aspects of a cochlear implant, and the lifespan care of their child. Hence, professionals should provide regular, and context-specific counseling to parents after implantation to understand the parents' concerns, and provide appropriate remediation.


Asunto(s)
Implantación Coclear , Implantes Cocleares , Sordera , Niño , Humanos , Preescolar , Estudios Retrospectivos , Sordera/rehabilitación , Implantación Coclear/métodos , Padres/psicología , Comunicación
20.
Am J Trop Med Hyg ; 109(3): 600-607, 2023 09 06.
Artículo en Inglés | MEDLINE | ID: mdl-37487562

RESUMEN

COVID-19-associated rhino-orbital cerebral mucormycosis (ROCM) has a rapidly evolving course with high morbidity and mortality. We describe imaging features of COVID-19-associated ROCM based on noncontrast computed tomography (NCCT). This retrospective single-center observational study included 50 patients with COVID-19 from January 1, 2021 to June 30, 2021 who subsequently developed ROCM confirmed by fungal culture studies. All patients underwent NCCT of the paranasal sinuses as the diagnostic workup. The involvement of the nasal cavity, paranasal sinuses, orbits, and intracranial cavity was identified and graded. The ethmoid sinuses were most commonly involved [right (n = 46 of 50) > left (n = 45 of 50)], followed by the maxillary, sphenoid, and frontal sinuses. Thinning and erosions of the hard palate were noted in 18% of patients (n = 9), whereas 34% (n = 17) showed dehiscence of the lamina papyracea. Retromaxillary fat stranding was noted in 68% of patients (n = 34). Severe ethmoid sinusitis was associated significantly with ipsilateral pterygopalatine fossa involvement. The extraocular muscles were involved in 64% of patients (n = 32), with 84% (n = 42) showing orbital fat stranding. Proptosis of the affected eye was seen in 66% of patients, optic nerve involvement in 52%, and irregularity of globe contour in 12% (n = 6). The cavernous sinuses were affected in 10% of patients (n = 5), with three of them having temporal infarcts. COVID-19-associated ROCM is an acute, invasive fungal disease characterized by multisinus involvement, often with orbital and intracranial extension. Bilateral involvement with rapid progression should alert one to underlying COVID-19 disease.


Asunto(s)
COVID-19 , Oftalmopatías , Mucormicosis , Humanos , Mucormicosis/diagnóstico por imagen , Estudios Retrospectivos , COVID-19/diagnóstico por imagen , Nariz , Tomografía
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