Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study.

BACKGROUND: Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS: Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS: A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION: A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.

Bacteriology of Adenoids and Tonsils in Children With Recurrent Adenotonsillitis.

INTRODUCTION: Recurrent adenotonsillitis (AT) commonly affects children and may be associated with various complications. Infections are common etiology, and microbial profiles may vary widely in different cases. In this study, we evaluated the bacterial profile and antibiotic sensitivity of pathogens identified in tonsil and adenoid core cultures in children with recurrent AT. METHODS: In this cross-sectional, observational study, culture and antibiotic sensitivity were performed from tonsil and adenoid core samples obtained after adenotonsillectomy of children (5 to 18 years) with recurrent AT. Children who had received antibiotics within one week before surgery were excluded. Drug sensitivity was performed only for drugs available on the hospital panel list. RESULTS: Bacterial growth was observed in 83 (91.2%) tonsil core cultures (n=91) and 43 (79.6%) adenoid core cultures (n=54). In the tonsil and adenoid core cultures, poly-microbial growth was seen in 25 (27.0%) and 11 (25.6%) children, respectively. From the tonsil core cultures, the majority of the bacteria were sensitive to ciprofloxacin, ampicillin, piperacillin-tazobactam, cefoperazone-sulbactam, ceftazidime, cefotaxime, levofloxacin. From the adenoid core culture, the majority of the bacteria were sensitive to ciprofloxacin, ampicillin, piperacillin-tazobactam, cefoperazone-sulbactam, cephalexin, and cefotaxime. CONCLUSION: In recurrent AT, polymicrobial growth is not uncommon in both tonsil and adenoid core cultures. Identifying the correct pathogens and their antibiotic sensitivity patterns can help plan treatment strategies for the effective management of recurrent AT.

Management of Arteriovenous Malformation in Otolaryngology Practice: A Retrospective Study & Review of Literature.

Vascular malformations in the head and neck encompass a wide range of lesions and present an interesting challenge for the surgeon with their varied presentations. Early diagnosis and timely and adequate intervention help treat patients effectively. We reported our experience in the management of four patients diagnosed with low-flow venous malformation. Every patient was managed differently based on the site and size of the lesion, and all of them had the best outcome. 1 patient who had a smaller lesion was managed with oral propranolol, and 1 patient was managed with oral propranolol with local hot water injection. Two patients had larger lesions involving the airways and hence required an elective tracheostomy because of anticipated airway compromise, following which they were managed with intralesional sclerotherapeutic injection. As the lesion size shrank but remained, both underwent coblator-assisted tumor debulking at the end of two months. All four patients had a better outcome. Each patient received a different modality of treatment. No recurrences were noted in any of them. A multidisciplinary team approach resulted in a positive patient outcome. Vascular lesions should be considered in the differential diagnosis of a patient presenting with increasing dysphagia, dysphonia, or dyspnea. The cooperation of a skilled interventional radiologist cannot be over-emphasized.

Role of surface swab, core swab and fine needle aspiration in isolating the core bacteria in inflammed tonsils.

The microbial flora of 75 patients with chronic tonsillitis were sudied to identify the commonest organism causing chronic tonsillitis and to compare surface swab, fine needle aspiration (FNA) and core swab in isolating the pathogens. Staphylococcus aureus was the predominant isolate from surface core swab FNA and surface swab. In our study the correlation between surface swab with core swab was 47.9% and between surface swab with FNA 57.3%. The correlation between FNA with core swab of 69.3% showed that FNA for culture was superior to surface swab in predicting the core culture. Hence FNA of the tonsil has more advantage over the routinely performed surface swab in representing the core pathogen. Thus the rationale of treating chronic tonsillitis medically should be based on the knowledge of the common core pathogen.

Fungal laryngitis in immunocompetent patients.

The diagnosis of fungal laryngitis is often overlooked in immunocompetent patients because it is commonly considered a disease of the immunocompromised. Further confusion is caused by clinical and histological similarity to more common conditions like Leukoplakia. Demonstration of hyperkeratosis particularly if associated with intraepithelial neutrophils on biopsy should trigger a search for fungus using specialized stains. These patients usually present with hoarseness of voice. Pain is present inconsistently along with dysphagia and odynophagia. We present three cases of fungal laryngitis in immunocompetent patients out of which one underwent microlaryngeal surgery with excision biopsy. All these patients responded well with oral antifungal therapy.

Sino nasal teratocarcinosarcoma-an interesting clinical entity.

Sinonasal teratocarcinoma is a rare tumour of the paranasal sinuses. It was earlier termed as teratoid carcinosarcoma or teratocarcinoma. It is a highly aggressive tumour with a 5 year survival rate of 45 %. Here we report a case of sinonasal teratocarcinoma who was managed excision of tumour by lateral rhinotomy approach followed by radiotheraphy.

Modified radical mastoidectomy: a relook at the surgical pitfalls.

The primary aim of surgery for cholesteatoma is to eliminate the disease, to produce a safe and dry ear which is self cleansing, modify the anatomy of the tympanomastoid compartment so as to prevent recurrent disease and wherever possible to reconstruct the hearing mechanism. The advances in medical technology and the medical expertise gained over a period of time have greatly influenced the results in cholesteatoma surgery. The aim of the present study was to assess the intraoperative findings during revision mastoid surgery for atticoantral disease and to ascertain the preventable factor that could reduce recurrence. A retrospective analysis of all clinical data and operative notes of patients who had undergone revision surgery for recurrent cholesteatoma, in our unit in a tertiary care centre in south India over a period of 3 years from July 2007 to July 2010 was done. 33 patients had undergone revision mastoid surgery for cholesteatoma. Most patients presented with symptoms and sign of disease about 2 years after the first surgery. The commonest complaint was recurrent foul smelling ear discharge. The most frequent site of recurrent cholesteatoma was the tip cells (72%) and the most important cause for failure of surgery with recurrence of disease was inadequate meatoplasty (70%). In our study, recurrent disease was likely due to cholesteatoma in the tip cells left uncleared and inadequate meatoplasty. Both these issues reflect faulty techniques in performing good meatoplasty or the tip cell are not adequately reduced into the external auditory canal. Bone work is generally taught well in all temporal bone workshops but no emphasis is laid on soft tissue work hence the failure and recurrence. Thus we emphasize the need to teach the budding otologists the importance of and proper technique of meatoplasty.

Schizophyllum commune a causative agent of fungal sinusitis: a case report.

We present a case of maxillary sinusitis caused by Schizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates.

Tracheostomal myiasis: a case report and review of the literature.

"Myiasis" is considered in Hindu mythology as "God's punishment for sinners." It is known to infest live human or animal tissue. Literature abounds with reports of myiasis affecting the nasal cavity, ear, nonhealing ulcers, exophytic malignant growth, and cutaneous tissue. But report of myiasis of the tracheal stoma is rare. Only a few cases of tracheal myiasis have been reported in literature. We report a case of tracheostomal myiasis in an elderly male. The species which had infested the stoma was identified as Chrysomya bezziana, an obligate parasite. This is to our knowledge the first case report of an obligate parasite (Chrysomya bezziana) infestation of the tracheostoma from India.

Giant tumour of the pterygopalatine fossa.

Neurilemmomas are benign and slow growing tumours. Neurilemmomas of the pterygopalatine fossa are rare. In this paper we present a case of schwannoma arising in the pterygopalatine fossa with extension into infratemporal fossa and floor of the orbit. A transantral approach was used for excision of the tumor following which the defect in the floor of the orbit was reconstructed with the help of a temporoparietal flap.

Functional study of nasal mucosa in endoscopic sinus surgery and its correlation to electron microscopy of cilia.

The effect of functional endoscopic sinus surgery (FESS) was evaluated in 20 patients with chronic sinusitis. The physiological function of sinus mucosa and its mucociliary transport mechanism was assessed pre and post operatively in patients undergoing FESS by performing Saccharin clearance test. The effect of functional sinus surgery on nasal mucosa was evaluated using scanning electron microscopy and study of the ultrastructure of cilia in pre and post operative patients and correlation with histopathological examination. The mucociliary transport mechanism of the sinus mucosa improved 6 weeks following surgery. Histopathologically there was evidence of improvement in the ciliary population and decrease in inflammation, ulceration, fibrosis, vascular congestion, edema, squamous cell metaplasia, basement membrane thickening and polyp formation in comparison to the diseased mucosa sampled preoperatively. Scanning electron microscopic examination revealed considerable increase in the ciliary area as well as the orientation of cilia. Subjective improvement 6 weeks following surgery was confirmed by decrease in saccharin test time. This study revealed that FESS is an effective surgical procedure in chronic sinusitis and improves the overall function of the sinuses.

Inflammatory pseudotumours of the paranasal sinuses.

Inflammatory pseudotumors are clinocopathologically distinctive but biologically controversial entities. They have been described in the lungs, abdomen, retroperitoneum and extremities, but rarely affect the head and neck region. This report is of 2 cases of pseudo tumor of the paranasal sinuses with varied clinical presentation and successful outcome following treatment.