The Role of Montelukast Sodium in Children with Adenoid Hypertrophy - A Comparative Study.

Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5 mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration . Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative .

A follow-up study of surgically managed benign vocal cord lesions using vocal handicap index - 10 score.

Background and Objectives: Benign lesions of the vocal cords not only impair the patient's ability to communicate due to poor pronunciation and voice capabilities, but they also cause a variety of psychological and social problems, worsening their quality of life. To assess voice handicap, Voice Handicap Index (VHI)-10 is an easy-to-administer, valid and reliable tool. The present study was conducted to compare the pre-operative and post-operative well-being of patients with benign vocal cord lesions using VHI-10 among patients attending our Outpatient department. Materials and Methods: The study was a hospital based observational study with prospective study design, conducted over a period of 17 months (August 2019 to December 2020) on 53 patients who were clinically diagnosed to have benign vocal cord lesion and underwent micro laryngeal surgery followed by histopathological confirmation. Follow-up of the participants was done on 4th and 8th week post-operatively. Visualization of the condition of the laryngeal structures using laryngoscope assessment of VHI-10 score was done at each follow-up visit. Results: In our study, out of 53 study participants, approximately one-third of the cases were seen in the 5th decade, that is, 40-49 years. The mean (±SD) age of the study participants was 43.2 (±12.1) years. There was male predominance (73.6%) with male to female ratio of 2.78:1. Majority of the patients had voice-demanding profession with history of vocal abuse. In cases of non-professional voice users, the highest incidence was noted in homemakers (11.4%). Smoking was noted in nine male patients while all the female patients were non-smokers. Habit of alcohol consumption was seen in 15.1% patients and 7.5% patients had habit of other substance abuse such as tobacco chewing, betel nut chewing, etc. Vocal polyps were the most common benign lesions found in 43.3% of the patients. Preoperatively mean (± SD) VHI-10 score was 20.7 (±3.5) which significantly decreased to 12.6 (±2.5) at 4th week post-operatively and 8.5 (±2.3) at 8th week post-operatively. Mean differences between pre-operative and post-operative scores were statistically significant (P < 0.01), depicting that there was improvement in the voice of the patients post-operatively. Conclusion: The VHI-10 scale is shown to be a good and convenient tool for assessing patient voice handicap and determining improvement post-operatively. Wider studies with larger sample size in different parts of the country may be recommended to validate the findings of the study. In addition to surgical excision of lesion, speech therapy, and patient counselling are indubitably essential measures that should be undertaken for each patient so as to alleviate the handicapping effect of voice disorder and improve the overall quality of life of the individuals.

The role of oral vitamin D3 supplementation in the treatment of Chronic Rhinosinusitis in adults with Vitamin D deficiency.

BACKGROUND: Chronic Rhinosinusitis (CRS) is a chronic inflammatory disorder of the mucosal lining of the nose and paranasal sinuses. The ability of Vitamin D (VD3) to augment innate and adaptive immune responses has sparked interest in its immunologic role in the treatment of CRS. In this study, the incidence of vitamin D deficiency in CRS patients was compared to normal population and the beneficial role of Vitamin D supplementation in its treatment was also evaluated. MATERIALS AND METHODS: It is a retrospective 1-year study of 200 CRS patients with Vitamin D deficiency. The patients were divided into two groups, i.e. 100 patients were given oral Vitamin D supplements and the other group of 100 patients were treated as placebo. Both Vitamin D levels and the Total Nasal Symptom Score (TNSS) were assessed at the start and end of the study period. RESULTS: Of the 200 subjects with CRS, 100 were given oral vitamin D supplementation in the form of Cholecalciferol 60000IU weekly once for 3 months and the other group were treated with placebo. Before the treatment, the average level of serum Vitamin D was 12.31 ng/ml. After 3 months, it increased significantly to 29.71 ng/ml. Similarly, the pretreatment TNSS score was on average 11.92. After 3 months, the scores fell by an average of 10.65 points, a significant statistical difference (P < 0.05). CONCLUSION: There is a higher prevalence of vitamin D deficiency in CRS patients and that vitamin D supplementation in these patients went a long way in alleviating their symptoms.

Laryngeal rhinosporidiosis: An airway catastrophe averted.

Rhinosporidiosis is a type of nasal polypoidal growth arising from the mucosa of nasal cavity and often extending to nasopharynx. Occasionally, this growth may invade the lower airways and cause airway obstruction. The clinical presentation of such cases is often contradictory and airway management during induction of anesthesia requires caution to prevent potential life-threatening situations. A case of large pedunculated rhinosporidiosis involving the epiglottis and laryngeal inlet, with significant airway management challenge has been presented here. Clinical significance: Primary care physicians should be diligent in evaluating patients with rhinosporidiosis and look for signs of airway obstruction to rule out lower airway involvement.

Polypropylene in Endoscopic Dacryocystorhinostomy: A Novel Stent.

Endoscopic dacryocystorhinostomy (DCR) is usually done in cases of lacrimal apparatus obstruction. The common causes of failure are that of obstruction in the common canaliculus and closure of the rhinostomy site. To overcome these problems we use stents. Stents most commonly used are that of silicon which are expensive and not readily available. As an alternative, polypropylene (Prolene; Ethicon) is used as a stent which is cheaper and readily available. This study is done to evaluate the clinical efficacy and results of stenting with polypropylene suture material in endoscopic dacryocystorhinostomy. Fifty one endoscopic DCR operations were performed between July 2013 to December 2014. After creating an aperture in the medial wall of the lacrimal sac, 3/0 prolene was inserted from lower punctum to neo ostium. The prolene was left in the lacrimal sac for 3 weeks. The patients were followed up for 3 months. In our study, most of the patients belonged to the age group of 41-60 years (47%). There was female preponderance as 64.7% were females. 47 patients (92.2%) showed very good results. Two patients (3.9%) developed granuloma for which revision surgery was done. We lost 2 patients during follow up. This modification enables an easy, safe, effective and low-cost form of DCR. Prolene is cheaper and readily available. It might be used successfully in endoscopic dacryocystorhinostomy and is promising alternative to silicone stent intubations, especially in settings with limited resources.

Total Reconstruction of Lower Eyelid in a Post-traumatic Patient Using Modified Fricke's Cheek Flap.

Eyelids are very complex structure, reconstruction of which is a challenge to surgeons. Reconstruction of eyelids may be required in a variety of conditions like congenital anomalies, trauma, or postsurgical excision in malignant lesions involving the eyelids. There are numerous ways to reconstruct the eyelids; the best procedure depends on both the skill of the surgeon and the condition of the patient. Fricke' lateral temporal based flap was first described in 1829 for reconstruction of the eyelids and lateral canthal region. This flap had inherent problems regarding cosmetic appearance of the eyebrows. The modified Fricke's flap based on the cheek has the advantage of avoiding such complications. It is very easy and rapid outpatient department (OPD) based procedure with acceptable cosmetic and functional result. It can be done by all ear, nose, and throat (ENT) and head and neck surgeons without any reconstructive training. In this article we are presenting a case of total reconstruction of lower eyelid using the modified Fricke's cheek flap.

Pattern of Nonmelanoma Skin Cancers in Sikkim, India: A 3-year Clinicopathological Review.

Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC), in combination, are referred to as Nonmelanoma skin cancers (NMSCs). NMSC has not been extensively studied in the population of the North eastern India as it has been done in the rest of India. This study was performed to understand the pattern of NMSCs in head and neck region in Sikkimese population. The present study is a retrospective analysis of NMSC of head and neck region that presented to the Department of ENT, Sikkim Manipal Institute of Medical sciences (SMIMS), a tertiary care center in Gangtok, Sikkim from July 2009 to July 2012. They were reviewed according to age, gender, site of involvement and histological types. Of the thirty-seven cases of NMSC analyzed during the 3 year study period, 24 cases were SCC and 13 cases were BCC. The most common age group for SCC was 40-50 years and BCC was 61-70 years. The most common site for both SCC and BCC was the upper lip. For SCC, the most common histologically type was well-differentiated and for BCC, it was the solid type. NMSCs comprise a small but significant proportion of all skin cancer patients in the world. SCC is the commonest variety unlike in western countries. The importance of understanding the risk factors as well as studying the frequency of histopathological patterns can help in the overall prognostic outlook for patients and also in planning an effective management.

Fractured tracheostomy tube as foreign body bronchus: our experience with three cases.

OBJECTIVE: Tracheostomy tubes are extensively used in paediatric age group for airway issues. Their fracture and lodgement into trachea is an acute emergency requiring urgent intervention. CASES: We report three such paediatric cases having tracheostomy tube fracture and aspiration into trachea with different presentations and treatment outcomes. RESULTS: One patient was successfully managed with bronchoscopy and fractured tube removal. One patient succumbed to asphyxia before any intervention. The third patient was having supratubal tracheal stenosis making things more dangerous, but was managed successfully by tracheoscopy through tracheostomy opening with removal of fractured tube. CONCLUSION: Immediate identification is the key to successful management of this rare but life threatening situation. In the presence of tracheal stenosis above the tracheostomy opening, situation becomes more dangerous with very limited options for management.