The Nasal Microarchitecture: How Does Tracheostomy Affect it?

This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.

Anatomical Variations of Sphenoid Sinus in South Indian Population: All That You Need for Trans-Sphenoidal Pituitary Surgery.

Pituitary adenomas are one among the most common neurosurgical tumors with an incidence of 10-25% among intracranial neoplasms (Ezzat et al., Cancer 101:613-619, 2004). Surgical management for the same has been practiced since long, and has evolved from trans cranial approach to endoscopic trans sphenoidal method (Hammer and Radberg, Acta Radiol 56:401-422, 1961). Preoperative radiological analysis with CT &MRI is inevitable in planning endonasal trans-sphenoid surgery to avoid complications because of the high variability concerned with sphenoid anatomy. The present study intends to analyze the incidence of various anatomical variations of sphenoid sinus in a cohort of south Indian population as detected by CT& MRI and assess its impact on surgical approach. Retrospective analysis of CT&MRI images of patients who underwent Endonasal Trans-sphenoidal resection of pituitary tumors at JSS Hospital Mysuru from a period of 2009 to 2020 is done. Anatomical variations of sphenoid sinus esp. degree of pneumatization, sellar configuration, septation pattern, inter carotid distance were evaluated. Results were significant and in concordance with other similar studies. Most frequently encountered pnuematization was sellar type and least was conchal type Sphenoid sinus pneumatization is directly linked to safe access to sella. Presence of septae within sinus need to be identified preoperatively to avoid damage and confusion intraoperatively. A meticulous preoperative analysis of sphenoid sinus anatomy will help surgeon in smooth conduct of a complication free surgery.

Assessment of Rhinostomy Parameters in Endonasal Dacryocystorhinostomy.

Epiphora is a bothersome condition seen in chronic dacryocystitis. The mainstay of treatment is surgical, that is creating an opening to establish a drainage pathway. With the advent of endoscope, endonasal DCR has gained popularity. Use of silicone stent in endonasal DCR has added advantage in improving the surgical outcome. And the use of DOS system in improving the success rates of endonasal DCR: (Mohammad et al. in Clin Ophthalmol 8:2491-2499, 2014) a total of 35 patients with chronic dacryocystitis were subjected for endonasal DCR with silicone bicanalicular stent. Patients were followed up at an interval of 1 week, 3 weeks, 6 weeks and 6 months post surgery. DCR ostium parameters were evaluated using DOS system. Silicone stent removal was done at sixth week and evaluated for success. The success rate in our study was 89%. The DOS score of the patient with successful surgery had a score of more than 30 and in the failed cases the score was between 22 and 28. The success rate of the procedure primarily depends on the ostium parameters and the position of the silicone stent. The DOS scoring system can be suitable tool in evaluating the same.

Ingrained Insight into Nasal Polyposis; Role of Human Papillomavirus: An Indian Study.

Nasal polyposis (NP) are benign lesion of nasal cavity, affecting up to 1-4% of population. It is known to have up to 70% recurrence rate. The underlying pathophysiology is still undetermined. Recent literatures have thrown light on the viral aetiology for NP. To our knowledge this is the first Indian study done, that aims to evaluate the prevalence of Human papillomavirus (HPV) in NP. It was a prospective case control study done among 40 individuals with NP and 40 healthy controls in a tertiary care centre. All the patients were subjected to routine clinical evaluation, investigations prior to proposed surgeries. The mucosal samples after the surgery were subjected to HPV DNA analysis by RT-PCR. Among the cases, the male to female ratio was 1.3:1. The mean age of patients with NP was 39 ± 14.6. The mean serum IgE levels among the case were 154 IU/ml and was significantly higher as compared to controls. Other inflammatory markers such as absolute eosinophil count, erythrocyte sedimentation rate, and neutrophil to leukocyte ration were found to be not significant. There was no HPV DNA detected among both case as well as controls. There seems to be strong association of IgE and NP, suggesting an IgE mediated pathway for its Causation. There is no association of HPV in NP.

Assessment of Quality of Life and Symptoms in Non Syndromic Paediatric Obstructive Sleep Apnoea Patients: Before and After Adenotonsillectomy.

This study aims to assess the improvement in quality of life and symptoms in paediatric obstructive sleep apnoea patients before and after adenotonsillectomy. From all paediatric patients who presented to our OPD with complaints of mouth breathing and snoring, a subset of patients fulfilling our inclusion criteria were selected and evaluated with PSQSRBD scale, quality of life (QoL) inventory and PSG level-III. Later37 patients who had moderate to severe OSA were selected for study and underwent adenotonsillectomy. They were further followed up postoperatively at 3 months and 7 months with PSQSRBD Scale and QoL inventory. The study cohort had 37 patients with moderate to severe OSA, with a mean age of 8yrs.The postoperative (mean of 3rd and 7th month) values of PSQSRBD Scale and QoL inventory values was significantly (p < 0.001) reduced compared to preoperative Values after adenotonsillectomy. There is statistically significant correlation between adenoid and tonsil size to the relief of symptoms (PSQSRBD SCALE values) and improvement of quality of life. In our study, surgical (adenotonsillectomy) intervention has significant effect in management of moderate to severe non syndromic paediatric OSA patients.

A Study on Surgical Implications and Variations of Suprameatal Spine and Other Landmarks on the Lateral Surface of Temporal Bone.

Mastoidectomy forms the main surgical procedure for eradication of disease in chronic otitis media. Such a surgery which contemplates a complete exenteration of all the tympano-mastoid cavities is rightly considered as a difficult one mainly because a large number of vitally important structures are crowded together in the small field of operation and there is always a risk of damaging them. It is therefore, extremely important that the otologist who would undertake this surgery be thorough with the details of the surgical relations of this region. Out of the various structures seen on the lateral surface of temporal bone one very important structure is the suprameatal spine. It is shown to have great variations in shape and size and has been a mystery to researchers due to the implications it is known to have on mastoid region anatomy. In this study we have evaluated the various types of suprameatal spine, prevalence of each type and the effect of each to other landmarks encountered during surgery and also the effect of mastoid pneumatisation on the same.

Extended Surgical Implication of Tubercle of Zuckerkandl in Total Thyroidectomy.

The primary objective of the study was to assess the Tubercle of zuckerkandl (TZ) during thyroid surgeries and its relationship with RLN and Superior parathyroid (SP). A prospective study was done in, 30 consecutive cases of total thyroidectomy in whom per operatively TZ was identified. The presence of TZ, its laterality, size, relationship with RLN and parathyroid glands were documented. A grading system outlined by Pelizzo was applied in our current study. In majority of the cases the RLN was found to lie medial to TZ (26/30), followed by lateral position (3/30) and one case it was found to be posterior to TZ (1/30). The superior parathyroid was identified in close relation (< 2 cm) to the TZ in 27/30 cases. The distance between the TZ and SP was assessed. We proposed a classification for location of SP based on the distance between SP and TZ and also attempted to relate each class of SP location with TZ grade. There was strong association of Grade of TZ with the class of SP location (p value = 0.00046). TZ is constant surgical landmark with good reliability to identify the RLN and SP. RLN is found medial to TZ in majority of cases with few exceptions. SP is found to be closely associated with TZ in majority of cases and there is a strong relationship of proximity of SP and TZ with respect to TZ grade. Although this required further studies with larger population.

New Visionary in Upper Airway Surgeries-THRIVE, a Tubeless Ventilation.

THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies.

Hearing Loss-a Camouflaged Manifestation of COVID 19 Infection.

The symptomatology of novel Severe Acute Respiratory Syndrome Corona virus type 2 infection runs the entire gamut of mild to moderate and serious illness among the affected individuals. As listed in recent literature, respiratory, cardiovascular, gastrointestinal, olfactory and gustatory systems are commonly involved. With the growing knowledge about the disease, varied manifestations have been identified and lately, otorhinolaryngology dysfunctions in COVID 19 have been described. Hearing loss in COVID era is one of the emerging areas of concern and calls for further research in the field for the better understanding and treatment of this entity. This study was designed to assess the audiological profile among 100 mild to moderately affected COVID-19 individuals, so as to make a contribution to the emerging literature on otologic manifestations in COVID 19. In our case series, high frequency hearing loss and referred OAE was noted among significant number of COVID 19 positive patients. This was even observed in patients without any otologic symptoms. Hence, early identification and intervention if required helps to give a better quality of life to the patient.

Quest for the Ideal Nasal Pack in Post Operative Cases of Septo-Turbinoplasty: Study in a Tertiary Care Hospital.

To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints.

Epidemiology of SARS-CoV-2 infection in Karnataka State, South India: Transmission dynamics of symptomatic vs. asymptomatic infections

Background: In this report, we describe the epidemiology of SARS-CoV-2 infection, specifically examining how the symptomatic persons drove the transmission in the state of Karnataka, India, during the lockdown phase. Methods: The study included all the cases reported from March 8 to May 31, 2020 in the state. Any person with history of international or domestic travel from high burden states, those presenting with Influenza-like or Severe Acute Respiratory Illness and high-risk contacts of COVID19 cases, who were SARS-CoV-2 RT-PCR positive were included. Detailed analysis based on contact tracing data available from line-list of the state surveillance unit was performed using cluster analysis software package. Findings: Amongst the 3404 COVID-19 positive cases, 3096 (91%) were asymptomatic while 308 (9%) were symptomatic. Majority of the asymptomatic cases were in the age range of 16-50 years while symptomatic cases were between 31-65 years. Most of those affected were males. Cluster analysis of 822 cases indicated that the secondary attack rate, size of the cluster (dispersion) and occurrence of overt clinical illness is significantly higher when the index case in a cluster was symptomatic compared to an asymptomatic. Interpretation: Our findings indicate that both asymptomatic and symptomatic SARS-CoV-2 cases transmit the infection; however, the main driving force behind the spread of infection within the state was significantly higher from symptomatic cases. This has major implications for policies related to testing. Active search for symptomatic cases, subjecting them to testing and treatment should be prioritized for containing the spread of COVID-19.

Contrasting Surgical Management of CSF Leak from Lateral Recess of Sphenoid Sinus and Its Surgical Outcomes: Our Experience.

CSF leak from Lateral Recess of Sphenoid (LRS) sinus accounts for 35% of all CSF rhinorrhoea cases. There are various surgical techniques described for repair of LRS CSF leak. This study describes the experience of LRS leak repair in a tertiary care center with three different surgical techniques. Study comprises of 3 cases of LRS CSF leak that presented to J.S.S. Hospital, during the time period of July 2018-January 2019, who underwent endoscopic CSF leak repair. All three cases underwent endoscopic endonasal transpterygoid approach to the leak site. The closure technique opted for all three cases were different. For the first case free mucosal flap from ipsilateral middle turbinate was used, for the second ipsilateral nasoseptal flap (NSF) was used and contralateral NSF was used for the third. All the cases were followed up for a minimum of 3 months. In all the 3 cases the CSF leak site was located in the lateral recess of Sphenoid sinus. Encephalocele was noted in two cases, which were cauterised and closure was done as planned. Crusting was more in cases that underwent closure using free mucosal flap. Healing and take up was similar for both the ipsilateral NSF and contralateral NSF. The endoscope has revolutionized the management of CSF leak from the lateral recess of sphenoid sinus. These defects can be managed efficiently using multilayer closure of defect. For large defects, the Posterior nasoseptal flaps can be used. In addition, contralateral PNSF has lower chances of being devascularized due to injury to pedicle while drilling the pterygoid plates.

Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India.

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility-Pseudomonas aeruginosa was sensitive to Cefoperazone-Sulbactam (96%), Imipenem (82%), Piperacillin-Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

Modelling, characterization and quality analysis of heated oil using electric moment and chemical properties.

The effect of temperature (30-90 °C) on the electrical parameter: dielectric constant (εr) of Sunflower, Olive and Corn oil exposed to three cycles of heating to frying temperature (175 ± 5 °C) was studied to exhibit the quality analysis of oil. Dielectric constant of heated oil was measured using designed inter-digitated electrode capacitor at different frequency (10 kHz-5 MHz) and temperature (30-90 °C). Dielectric constant (εr) of oil samples increases with cycles of heating. Variation of dielectric constant with frequency was premeditated using quadratic equation and the dependency factor was observed to be R2 > 0.914. Chemical kinetic dielectric constant with temperature was studied using Arrhenius law and observed that activation energy increases with cycles of heating. Andrade's equation was also fitted with the variation of εr with temperature and the dependency factor (R2 between 0.978 to 0.999) was observed to be highly correlated. Experiential physical properties like density, refractive index and εr were significantly correlated with the pragmatic peroxide value. The observed relation between εr with chemical property divulges the suitability of measured dielectric constant in real time and continuous evaluation of edible oil quality analysis in food industry.