Outbreak of Mucormycosis in Coronavirus Disease Patients, Pune, India.

We provide an overview of the epidemiology and clinical course of mucormycosis in the coronavirus disease (COVID-19) pandemic era. We conducted a retrospective chart review of 178 patients with clinical or diagnostic, endoscopically or histopathologically confirmed rhino-sino-orbital or cerebral mucormycosis after COVID-19 treatment during the second wave of COVID-19 in Pune, India. Median time to symptom onset from COVID-19 detection was 28 days. Moderate or severe COVID-19 was seen in 73% of patients and diabetes in 74.2%. A total of 52.8% received steroids. Eschar over or inside the nose was seen in 75%, but baseline clinical and laboratory parameters were mostly unremarkable. Bone penetration was present in ≈90% of cases, 30% had soft-tissue swelling of the pterygopalatine fossa and 7% had cavernous sinus thrombosis, and 60% had multifocal mucormycosis. Of the 178 study cases, 151 (85%) underwent surgical debridement. Twenty-six (15%) died, and 16 (62%) of those had multifocal mucormycosis.

Correlative Multicentric Analysis of Dimensions of Nasopharynx and Adenoid Size, and its Burden in Otitis Media with Effusion: An Indian Scenario.

Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the middle ear cleft. It has been demonstrated both by radiological techniques and middle ear pressure studies that adenoids can and do obstruct the Eustachian Tube. The Adenoid-Nasopharyngeal Ratio (ANR), can offer a simple arithmetic measure of nasopharyngeal obstruction. Coupled with tympanometry, it also predicts the degree to which the middle ear is affected. Multicentric study done at two centres in India. 230 patients were studied. Children were in the age group of 5-14 years. The nasopharyngeal and adenoid dimensions were measured separately using the Fujioka method. The adenoid-nasopharyngeal ratio was derived by the arithmetic method. All patients were also subjected to tympanometry. ANR decreased from 0.728 to 0.663 with an increase in age from 5 to 12 years. ANR between 0.701-0.800 had maximum number of Type B (140) and Type C (71) Tympanogram whereas between 0.801 and 0.900, all Tympanogram were found to be of Type B or Type C with none belonging to Type A. Using ANR and Tympanometry, the effects of the adenoids on the middle ear can be quantified indirectly. Both these modalities are easily available, economical, safe and can be performed at the Out Patient Level. This aids in timely and appropriate management thus preventing discomforting symptoms caused by the adenoids locally and also the morbidity caused to the middle ear in the long term.

Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia.

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in post-tonsillectomy analgesia. Over a period of 1 year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24 h post operatively. Using Mann-Whitney non-parametric statistical test, inter-group analysis was done which showed highly significant p-value (<0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Effect of Deviated Nasal Septum on Mean Platelet Volume: A Prospective Study.

Nasal obstruction due to Deviated Nasal Septum (DNS) is a commonly encountered condition by the Otorhinolaryngologist. This leads to chronic hypoxia which in turn leads to stimulation of platelets. This change can be assessed by estimation of the Mean Platelet Volume (MPV) which is a commonly available investigation while ordering a haemogram. As there is a lot of conflicting data about the relationship between DNS and MPV, this study was undertaken to evaluate if there is a relationship between these two parameters. A 1-year observational study was done and after adhering to the inclusion and exclusion criteria, there were 50 cases of deviated nasal septum and 50 controls who attended the ENT Out-Patient Department of a tertiary care hospital who were evaluated. Blood was drawn and the Mean Platelet Volume was estimated. It was found that there was no statistical significance between the cases and controls. Contradictory to other studies done in literature, our study did not find any correlation. This could be due to the type of septal deviation cases that were part of our study. Hence, multicentric studies with larger samples need to be studied in order to establish sound conclusions.

Comparison Between Effectiveness of Topical Mometasone Furoate Nasal Spray Versus Topical Fluticasone Furoate Nasal Spray in the Treatment of Chronic Rhinosinusitis: A One Year Hospital Based Study.

To compare the effectiveness between topical mometasone furoate nasal spray versus topical fluticasone furoate nasal spray in the treatment of chronic rhinosinusitis. Randomized control trial was conducted involving 70 patients. One group received topical mometasone furoate nasal spray and the other group received fluticasone furoate nasal spray for 3 weeks. All patients were prescribed oral ciprofloxacin for 3 weeks and were subjectively evaluated using the Lund and Mackay staging system and objectively using nasal endoscopy by the Lund and Kennedy scoring system. There was no inter group significance but all patients improved significantly after the administration of either of the steroid sprays. Following administration of steroid nasal sprays, there was clinically significant improvement in the symptoms and signs of chronic rhinosinusitis, but there was no statistical significance between the two study groups. Thus, steroid nasal sprays significantly improve the symptoms and resolution of signs of chronic rhinosinusitis. The choice of drug still remains uncertain to the clinician. However, long term studies with more sample size is needed to arrive at sound conclusions.

Study of Efficacy of Intraoral Submucosal Injections of Corticosteroids and Placentrex in the Management of Oral Submucous Fibrosis.

In a country such as India, popularly known for its rich diversity and traditions, chewing tobacco and its many other forms is a commonly practised entity. The resultant of this leads to oral submucous fibrosis (OSMF) which causes permanent morbidity in the form of trismus and also can lead to potential possibility of oral cancer. Intra oral injections of steroids such as hyaluronidase and placentrex have been postulated by many studies. But this study was done to evaluate the efficacy of both these commonly used treatment modalities. A 1 year hospital based study was performed over 30 patients diagnosed to be having oral submucosal fibrosis. They were randomly given injection hyaluronidase and injection placentrex. In addition to this, routine haemogram was done and the inter incisor distance was measured before and after the treatment along with histopathological study of the oral lesions. With a prevalence of 0.31%, the males out numbered females. Majority of the patients were in their third decade. All patients chewed tobacco in one or the other form and 90% of them presented with burning sensation in the mouth. The mean inter incisor distance in our patients was 3.1%. A third of the cases were anaemic and two thirds had an elevated erythrocyte sedimentation rate and serum globulin level. More than half the cases had an elevated absolute eosinophil count. All 30 biopsy specimens showed atrophic oral mucosa with subepithelial dense collagenised fibrous tissue. The group of patients who were treated with injection placentrex showed slightly better results than corticosteroids. The results were not statistically significant although clinically they were noteworthy. Being a silent, chronic disease, oral submucosal fibrosis affects the most productive population fraction of our country causing morbidity and also acts as precursor for oral cancer. Since the etiological agent is chewing areacnut in one form or the other, considerable efforts have to be made in sensitizing the workforce of the nation at the community level in understanding the ill effects of chewing tobacco. Understanding the associated conditions such as anaemia, elevated erythrocyte sedimentation rate, serum globulins and absolute eosinophil count should prompt the otolaryngologist in treating these patients holistically. Though injection placentrex yielded better improvement in the inter incisor distance, the results with steroid injection was also comparable with no statistical significance. Hence, keeping the premalignant nature of the disease, screening the patients promptly and treating them on time would lead to considerable reduction in the morbidity caused by the disease. Coupled with health education, the results could be even more encouraging.

Correlation Between Allergic Rhinitis and Body Mass Index: An Observational Study.

Allergic rhinitis is one of the most rampant diseases in the world and many studies have been conducted to find its risk factors. Various studies have shown that there is a correlation between allergic rhinitis and increased Body Mass Index (BMI). Obesity has several effects on the immune system that could play a major role in increasing allergic disease. Allergic rhinitis is known to produce mild eosinophilia. The purpose of this study is to assess the correlation between BMI and allergic rhinitis using the Absolute Eosinophil Count (AEC). Over a period of 6 months, 55 cases of allergic rhinitis were selected. The patients were investigated by Absolute Eosinophil Count and their Body Mass Index values were calculated based on weight and height measurement. There was a positive correlation between Absolute Eosinophil Count and BMI with a p value of < 0.0001 which in turn revealed a positive correlation between BMI and allergy. We conclude that patients with high BMI are more prone to allergic rhinitis and have higher Absolute Eosinophil Counts probably due to the immunological effects of adipose tissue on the progress of the allergic disease.

Subjective and Objective Outcome Assessment in Patients with Sinonasal Disease After Microdebrider Assisted Endoscopic Sinus Surgery.

Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suction. The present study aims to assess the subjective and objective outcome in patients with sinonasal disease after microdebrider assisted endoscopic sinus surgery. A prospective observational study was carried out among 40 patients with symptoms suggestive of sinonasal diseases willing to undergo microdebrider assisted sinus surgery at our tertiary care hospital from January 2019 to December 2019. All the patients underwent microdebrider assisted endoscopic sinus surgery (ESS). Patients were subjectively evaluated using the Lund and Mackay staging system using visual analogue score and objectively using nasal endoscopy by the Lund and Kennedy scoring system preoperatively and post operatively after 6 weeks. 40 patients were included in the study. A mean age of 37 years were noted. All patients showed significant statistical improvement in Lund Mackay scoring system by visual analogue scoring and Lund Kennedy endoscopic scoring postoperatively. Thus, microdebrider offers a better therapeutic approach for patients with sinonasal diseases when compared to endoscopic surgery with the conventional instruments. The advantage of using microdebrider in ESS remains to be proper removal of the pathology, good surgical field and better postoperative outcome.