Alterations in Smell During Pregnancy: Myth or Fact?

To compare the olfactory functions of pregnant and non pregnant females draining the tribal tertiary care centre. Odor identification (OI), odor discrimination (OD) and odor threshold (OT) in subjects and control group with no previous Sino-nasal symptoms or pathology were included in the study. Mean scores of all the parameters were calculated in both the groups. Group A being of 60 pregnant females in 1st trimester and Group B constituted 60 non pregnant females as control group. Both the groups were matched for Age and Normal Mucociliary clearance range. Modified Indian Smell Identification Kit was used to assess all parameters. Before doing objective olfactory assessment all the study participants were given questionnaire for subjective assessment of olfaction in which we found significant impairment in drinking beverage and fragrance perception of flowers in pregnant females compared to non pregnant females. We also found there was no significant difference in mean scores of various olfactory parameters in multigravida and non pregnant females. The mean OI score in both groups was 9.54 ± 1.87 and 8.70 ± 1.62 respectively. Mean OD score of the two groups was 8.80 ± 2.61 and 9.80 ± 2.61 respectively and the mean OT score of both the groups was 6.99 ± 4.63 and 4.13 ± 2.48 respectively.

Neck Masses: Clinico-Radio-Pathological Evaluation.

Neck masses are defined as any swelling or enlargement of the structures in between the inferior border of mandible and clavicle and are a common clinical finding that can be encountered in patients of all age groups. There are many potential causes of neck masses so it is important to proceed in affordable, easy available and cost effective diagnostic technique for the proper and early diagnosis of neck masses. As there is very few study data available over clinico-radio-pathological analysis of neck masses, that's why this study is done. The present study has been carried out on 200 patients with clinically palpable neck masses presenting at ENT department in a tertiary care hospital. Neck swellings were classified into four main headings i.e. Lymph node swelling, Thyroid swelling, Salivary gland swellings and Skin and soft tissue swelling. After taking detailed history followed by complete General, Local and ENT examination, FNAC was done followed by USG. We came to the conclusion that neck masses have very variable presentations, and FNAC is a riskless, easy and fast tool which can be used in forming a diagnosis and appropriate management of neck masses.

Correlation of Preoperative 'HRCT Temporal Bone' Findings with 'Surgical Findings' in Unsafe CSOM.

To assesses the usefulness of a preoperative HRCT temporal bone and establish HRCT as an efficacious tool for diagnosis of the extent and involvement of adjacent structures by Cholesteatoma. The study group includes 52 patients with Unsafe CSOM (atticoantral), who presented to the ENT OPD at a tertiary care centre in Central India over a period of 18 months, who underwent HRCT temporal bone followed by surgical exploration of middle ear and or mastoid, for the removal of Cholesteatoma. From the observation and results obtained from this study, we can conclude that the HRCT can be used as a standard radiological imaging modality for the evaluation of temporal Bone pathology. Despite its pitfalls such as more radiation exposure and higher cost, delineates the location and extent of the disease and provides critical information regarding anatomical variations and complications. It serves as a roadmap to assist the surgeon during surgery.

Epistaxis: Revisited.

To study the age & sex distribution, etiology, formulate most suitable management protocol and evaluate the results of our study and compare our data with similarly published studies to look for any changing trends. All the patients presenting with epistaxis who came to our institute, a tertiary care centre of central India were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Total 304 patients were included in the study. Epistaxis was found prevalent in 1st to 3rd decade, more common in males, frequently seen in cold, anterior epistaxis more common. Trauma and infection being more common in children and young adults, whereas hypertension in the elderly. Although the treatment of epistaxis hasn't change much, we found cauterization to be a very efficient and effective method to control epistaxis and required less hospitalization.

Effect of Deviated Nasal Septum on Maxillary Sinus Volume and Occurrence of Sinusitis.

Nose is the central part of mid-face and has an important functional, aesthetic and psychological role. The first modern and accurate descriptions of the paranasal sinuses can be traced to the works of the late 19th century Austrian anatomist Emil Zuckerkandl. In our study we tried to relate deviated nasal septum (DNS) with occurrence of sinusitis and its effect on volume of the maxillary sinus. It is a pioneer study in the field of otolaryngology and not many studies have been conducted on this topic. This is a cross sectional study involving patients with deviated nasal septum and having symptoms of sinusitis like fever, general malaise, body ache, headache, pain, tenderness, nasal discharge and post nasal discharge. The study was conducted at the department of otolaryngology at a tertiary care center on 84 subjects out of which 71 patients got CT scan done, which were included in the study. All subjects having Grade 5 and 6 DNS showed blocked osteomeatal complex (OMC) on CT scan while in Grade 2 the occurrence was only 50%. This finding was suggestive of increase in incidence of OMC block with increasing grade of DNS. The maxillary sinus volume for the cases was seen maximum in range of 9.1-10 cu mm by software and in the range of 8.1-9 cu mm for geometric analysis. Cases with Grade 2 DNS showed maximum cases in volume range of 11.1-12 followed by 9.1-10. On the other hand volume by geometric analysis showed equal cases in range 8.1-9 and 10.1-11. The study showed strong association of blocked OMC with high grade DNS. It also showed reduced sinus volume in higher grades of DNS. Further studies are needed in this field with a higher number of subjects to establish the relation between decreased volume of maxillary sinus and grade of DNS.

Adverse Effect of Mobile Phone on Hearing in Healthy Individuals: A Clinical Study.

The mobile phone is a ubiquitous piece in this modern world. An estimated 85% of Americans, 80% of the British, and perhaps 75% of Indians use it, as of today. Mobile phones communicate by transmitting radio waves through a network of fixed antennas called base stations. Radio frequency waves are electromagnetic fields, and unlike ionizing radiation such as X-rays or gamma rays, can neither break chemical bonds nor cause ionization in the human body. 1000 participants from outpatient department of a tertiary care center over a period of one and a half years, were included in the study and were divided equally into case (> 1 year use) and control (< 1 year use) groups. Out of 500 cases, maximum 233(46.6%) subjects were using mobile since last 4-6 year and 134(26.8%) were using mobile since last 7-9 year and maximum 344(68.8%) subjects were using mobile 1-3 h/day and 145(29.0%) were using mobile 4-6 h/day.

Role of Otoacoustic Emissions in Hearing Assessment of Neonates: A Prospective Observational Study.

Hearing plays an important role for children in learning speech and language, socialization and cognitive development. The child learns to speak based on what is heard (Rundjan et al. in Sari Pediatr 6(4):149-154, 2005). The aim of the study was to find out the percentage of hearing loss by OAE among low risk and high risk neonates. All the neonates (Low and High risk) born in a tertiary care center were screened by OAE before their discharge from the hospital and after stabilizing high risk neonates. The referred neonates were followed after two weeks. Total 722 neonates were screened of which 130 were high risk and 592 were low risk. Neonates with Serum bilirubin > 20 mg/dl or requiring exchange transfusion were excluded as OAE will be unreliable in them and they should be subjected to BERA directly. Percentage of bilateral hearing loss came to be 4.2%, 4 participants were lost to follow up and percentage of hearing loss on subsequent OAE came to be 11.6%. Low birth weight was an important risk factor for hearing loss (p value significant on initial and follow-up). Percentage of hearing loss with low birth weight, hyperbilirubenemia, low apgar score and prematurity to be 16%. Mechanical ventilation contributed 13% of total hearing loss followed by ototoxicity. Neonates with family history of childhood SNHL, in utero infection, craniofacial anomaly and bacterial meningitis contributed 3% of total hearing loss. On subsequent follow-up, one neonate was low-risk and the other 25 were high risk, of which 3 high risks showed sustained OAE refer. However the low risk neonate had normal outer hair cell function i.e. OAE pass. This study clearly demonstrates importance of Universal Neonatal Hearing Screening Programme so that hearing loss can be detected as early as possible and possible intervention can be taken at the earliest.

"Sinus Headache": Diagnosis and Dilemma?? An Analytical and Prospective Study.

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations.

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.

Presentation of Lesions of Nose and Paranasal Sinuses at a Tertiary Care Center in Central India.

A variety of non-neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinus and are fairly common presentation encountered in clinical practice. Sinonasal lesions are a common finding in all age groups. The lesion of nose and paranasal sinuses are very deceptive so, the presenting features, clinical examination, nasal endoscopy, radiodiagnosis and histopathology are employed conjointly to reach a diagnosis. This cross sectional study was conducted between November 2014 and September 2016. 150 patients with nasal or paranasal sinus lesions attending ENT OPD were included. Among 150 patients there was a male predominance in all lesion except malignant lesions and most of the patients 72 (48%) were in the age group 11- 30 years. Mean age of presentation for benign lesions was 33.64 years and of malignant lesions was 49.14 years. The study showed that 96 (64%) of the nose and PNS lesions were of inflammatory nature followed by 22 (15%) benign, 18 (12%) granulomatous and 14 (9%) malignant, Inflammatory polyp being the most common diagnosis. Haemangioma was the most common benign neoplastic lesion whereas in granulomatous lesions most common diagnosis was tuberculosis. The maximum lesions 74 (49%) were in maxillary antrum. The most common clinical presentation was nasal obstruction, with unilateral nasal obstruction seen in 84 (56%) cases and bilateral nasal obstruction in 50 (33.3%) cases. Angiofibroma 6 (4%) was exclusively seen in adolescent males. Olfactory neuroblastoma 4 (2.6%) was diagnosed in females with mean age of presentation of 30 years. Sinonasal lesions display a complex and interesting spectrum of clinical, radiological and histopathologic features. The non-neoplastic lesions are numerous, the morphologic variants of neoplasms are many and most of them present as polypoid masses which are impossible to distinguish clinically. Hence a proper workup including histopathological and radiological categorization is essential in the management of these lesions.

Hand Dominance and Blood Group: Association in Epistaxis.

The present work was undertaken to study the association of epistaxis with hand dominance and blood group. The present cross sectional study was conducted among 360 cases of epistaxis who reported to the E.N.T outpatient department of tertiary care centre in central India during the period of July 2014 to July 2015. Examination was carried out by self prepared Performa which included demographic information, detailed history and clinical examination findings. Total of 360 patients were included in the study, the mean age being 31.2 years of which there were 208 males and 152 female. Most of the patients (48.9 %) presented with 4-6 episodes of nasal bleed per year. In present study, local trauma (22.2 %) followed by nose picking (16.7 %) were the commonest local etiological factors while Idiopathic thrombocytopenic purpura, pancytopenia etc. (15.6 %) being the commonest of general causes followed by hypertension (13.4 %). The study showed highly significant association of A+ve blood group with epistaxis (p = 0.002). Most of the patients (54.8 %) presented bleeding episodes mainly in summer season. In our study we found statistically significant (p = 0.0001) association of hand dominance and side of nasal bleeding. Anterior nasal bleeding was significantly more presenting symptom in all epistaxis patients. This study underlines the importance of epistaxis as the most frequent emergency diagnosis in ENT. The observed association of A+ve blood group and Hand dominance in epistaxis provokes to have further large scale studies in this area.

A Clinical Study of Oral Mucosal Lesions in Patients Visiting a Tertiary Care Centre in Central India.

The aim of this study was to find the frequency of various oral mucosal lesions in relation to age, sex, site and associated addiction habits. This retrospective study was done in tertiary care centre including 1280 patients of oral mucosal lesions. Clinical findings and detailed history of their addiction habits with frequency and duration was noted from the existing data. Cytological and histopathological diagnosis of various lesions was recorded to conclude diagnosis. The most common lesion in this study was found to be aphthous ulcers (44.5 %), followed by leukoplakia (12.9 %). The most common site of involvement was tongue in aphthous ulcers and buccal mucosa in leukoplakia. In the present study 66.46 % cases were non malignant, 21.2 % cases were premalignant and the remaining 11.9 % cases were found to be malignant. Oral lesions are common finding in patients presenting to ENT OPD. Aphthous ulcers are common oral lesions. A patient with oral mucosal lesion should be examined for dietary deficiency, systemic disease or premalignant state with simultaneous counseling to quit addiction.

Pre and Post Operative Status of Contralateral Ear in Unilateral Chronic Otitis Media.

Chronic otitis media (COM) is one of the oldest disease affecting ears and undoubtedly represents the main area of interest within modern otology. As the main cause of COM is malfunction of Eustachian tube, it is probable that a patient with COM will have a disorder in contralateral ear (CLE) as suggested by the Minneapolis group- called as Continuum Theory. This prospective, observational study was conducted in department of ENT at a tertiary care centre of central India from Sep 2012 to May 2015. Study consisted of 537 patients of unilateral COM who fulfilled the eligibility criteria. After careful history and thorough examination of diseased ear and CLE, findings of diseased ear, CLE and 6 months postoperative findings CLE were entered into performa. The data was entered into SPSS software and further analysis was performed. Out of 740 patients of COM operated in our department, 535 (72.9 %) patients had unilateral COM which were included in the study. The mean age was 24.3 (SD ± 10.63) ranging from 11 to 55 years, of these 51.4 % were females and 48.6 % were males. Out of 535 unilateral COM, 365 (68.2 %) had mucosal while 170 (31.8 %) had squamous type of disease and 30.9 % of total CLE had abnormal findings. The pre and post-operative findings were compared which came out to be statistically significant and there was significant difference in pre and post-op PTA also (0.001). The significant improvement in postoperative status of CLE achieves our objective and also strongly supports the theory of Continuum. The unilateral COM should not be taken as a static phenomenon but as a continuous process in other ear too. We could also shows a significant improvement in the CLE after treatment of diseased ear, this knowledge can be effectively used in therapeutic planning of diseased ear, counselling of patient regarding other ear and if necessary providing therapeutic intervention in the other ear at the earliest.

Nasal mass mimicking antrochoanal polyp.

Sphenochoanal polyp is a rare form of choanal polyp. As the name suggests, it originates from the sphenoid sinus and extends down the choana and nasopharynx. If wrongly diagnosed as an antrochoanal polyp, it can lead to unnecessary exploration of the maxillary sinus and incomplete removal of the sphenoid component of polyp. Here we report a case of 40-year-old woman who presented with history of progressive left nasal obstruction and mass in the oropharynx. A diagnosis of sphenochoanal polyp was made on the basis of nasal endoscopy and computed tomography scan. The polyp was removed endoscopically. We discuss the clinical presentation, management and review of the literature of this clinically mistaken entity.

An unusual cause of recurrent tonsillitis.

Primary tuberculosis of the oral cavity and oropharynx is quite uncommon, and primary isolated tuberculosis of the tonsils is extremely rare. We report a case of primary tonsillar tuberculosis, in an otherwise healthy man, mimicking chronic non-specific tonsillitis.