Role of narrow band imaging in detecting recurrence in patients of squamous cell carcinoma larynx and hypopharynx who underwent radiotherapy/chemo-radiotherapy.

Background: Narrow band imaging (NBI) is an emerging modality that enhances the accuracy of detection of head and neck malignancies by visualisation of aberrant neoangiogenesis in malignant tissue using narrow bandwidth light in blue and green spectrum. The purpose of this study was to assess the role of NBI in detecting recurrence in patients with Squamous cell carcinoma larynx and hypopharynx who have undergone Radiotherapy/Chemoradiotherapy (RT/CTRT). The aim of the study was to (a) determine the role of NBI in follow-up of patients with carcinoma of larynx and hypopharynx previously treated with radiotherapy or chemotherapy, (b) determine the role of NBI as the initial investigatory tool of choice in detecting local recurrence and compare with other modalities like fibreoptic laryngoscopy (FOL), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography- Computed Tomography (PETCT). Methods: Prospective multicentric study at ENT departments of tertiary care centres in Delhi, Bangalore and Pune in India was conducted from Jan 2019 to Sep 2022. Thirty-four consecutive patients diagnosed as squamous cell carcinoma (SCC) larynx/hypopharynx who underwent chemo/radiotherapy were scheduled for NBI 12 weeks after completion of therapy with FOL and PETCT/MRI and followed up 03 monthly for 02 years. NBI/FOL/PETCT or MRI and Histopathological Examination (HPE) were compared. Results: NBI was found to be 100% sensitive and 96% specific with a positive predictive value of 85% and negative predictive value of 100% respectively with a diagnostic accuracy of 97%. Conclusion: NBI along with FOL increases the sensitivity of detection of recurrence in patients of laryngeal/hypopharyngeal cancer post-chemo/radiotherapy.

A Study to Evaluate TIRADS Scoring in the Management of Thyroid Nodules.

INTRODUCTION: Thyroid nodules pose a frequent clinical dilemma, requiring the use of precise and expedient diagnostic methods. The effectiveness of the Thyroid Imaging Reporting and Data System (TIRADS) in relation to histopathology, which is considered the standard method, continues to be a prominent area of investigation. TIRADS provides a systematic evaluation based on ultrasound imaging. The primary objective of this study was to evaluate the reliability of the Thyroid Imaging Reporting and Data System (TIRADS) in the assessment of thyroid nodules, in comparison with histopathological findings. METHODS: A retrospective design was employed to analyze data obtained from a sample of 100 patients, ranging in age from 19 to 82 years. The main objective of the study was to assess ultrasonography (USG) findings using the Thyroid Imaging Reporting and Data System (TIRADS) as the major outcome measure. The secondary outcome measure was based on histological evaluations. Multiple statistical tests were utilized, such as linear regression and the kappa statistic. RESULTS: The outcomes of this study indicate a significant association between TIRADS and histopathology results, particularly in the higher risk groups. The study findings indicate that the diagnostic value of TIRADS III, IV, and V is supported by the respective malignancy risks of 4.1%, 90%, and 100%. CONCLUSION: The appropriate utilization of TIRADS can function as a dependable first method for evaluating thyroid nodules, although it is essential to supplement this approach with histological examinations in order to obtain a thorough understanding.

Enhancing BPPV Treatment Outcomes: A Comparative Study of the Epley Maneuver with and without the Dizzy-Fix Training Device.

INTRODUCTION: This study evaluates the effectiveness of combining the Epley Maneuver with the Dizzy-Fix Training Device in treating Benign Paroxysmal Positional Vertigo (BPPV), aiming to enhance treatment outcomes and patient satisfaction. METHODS: In this randomized controlled trial, 50 patients diagnosed with posterior canal BPPV were allocated into two groups: one receiving the traditional Epley Maneuver and the other undergoing the Epley Maneuver supplemented with the Dizzy-Fix Training Device. Key measures included the proportion of symptom-free patients at one month, changes in the Visual Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI) scores, the recurrence rate within one month, and patient satisfaction. RESULTS: The Dizzy-Fix group achieved a significantly higher symptom resolution rate by day 7 (90% vs. 60%) and reported greater patient satisfaction (4.5/5 vs. 3.8/5) compared to the Epley Maneuver alone group. Additionally, this group exhibited a more substantial decrease in DHI scores (from an average of 30 to 5) and a lower recurrence rate (10% vs. 40%) within the first month post-treatment. CONCLUSION: Incorporating the Dizzy-Fix Training Device with the Epley Maneuver significantly improves the management of BPPV, evidenced by faster symptom resolution, enhanced patient satisfaction, and reduced symptom recurrence. These findings underscore the value of integrating real-time visual feedback technologies in vestibular rehabilitation, promising better patient outcomes, and advancing the quality of care in BPPV treatment.

The Impact of Post-Birth Timing on OAE Test Efficacy: An Observational Analysis of Neonatal Hearing Screening.

Identifying auditory impairments early in newborns is essential to prevent developmental delays. Otoacoustic Emissions (OAE) screenings play a critical role in newborn hearing assessments. However, the ideal timing post-birth for these tests remains unclear. This study evaluates the efficacy of OAE screenings within the first five days after birth to determine the most effective timing. An observational study involved 1,013 full-term neonates at a tertiary care centre. These neonates underwent Transient Evoked Otoacoustic Emissions (TEOAE) screenings daily from Day 1 to Day 5, following WHO and JCIH guidelines. The study assessed pass rates, false positives, and false negatives, with follow-up screenings at one and three months for neonates with initial ambiguous results. The study found that screening efficiency significantly increased, with Day 1 pass rates at 8% (81 neonates) and 98% (992 neonates) by Day 5, marking a significant improvement in diagnostic accuracy (p < 0.001). False positive rates dropped from 92% on Day 1 to 2% by Day 5, and false negatives decreased to below 1%. Sensitivity and specificity reached their peak at 98% and 99.5%, respectively, on Day 5. Our study findings advocate for adjusting neonatal hearing screening protocols to include OAE tests on the fifth day post-birth, optimizing clinical efficacy through enhanced diagnostic accuracy and reducing the logistical and emotional burdens on families and healthcare providers. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04700-0.

Temporal Bone Fractures after Trauma: A Prospective Analysis of Presentation, Management, and Outcomes.

To comprehensively understand the manifestation, treatments, and resultant consequences of temporal bone fractures, given their substantial impact on auditory and balance systems and the overall quality of life. A prospective study, adhering to the STROBE guidelines, spanning five years (2011-2015) was conducted on 83 male patients aged between 20 and 54 years, diagnosed with temporal bone fractures primarily caused by road traffic accidents. Evaluations comprised symptom presentation, otologic manifestations, radiological classifications, and management strategies, including both conservative and surgical interventions. Our study found that patients commonly presented with symptoms such as Oto-haematorrhoea, hearing impairment, and vertigo. Specifically, longitudinal fractures were the most frequent radiological finding, occurring in 63 cases (p < 0.001 for road traffic accidents). In terms of treatment outcomes, there was a notable improvement in the average hearing threshold, decreasing from 50 dB to 25 dB post-treatment (p < 0.001), and the air-bone gap reduced from 30 dB to 10 dB (p < 0.001). Audiometric outcomes varied significantly with fracture type, showing severe hearing loss was more common in transverse fractures (50%, p < 0.001) compared to longitudinal and mixed fractures. Additionally, the study revealed a significant reduction in the incidence of post-trauma vertigo over eight weeks (p < 0.001), underscoring the importance of early and appropriate intervention in managing temporal bone fractures. Efficient early detection and tailored interventions for temporal bone fractures lead to optimistic results. This research underscores the imperative for healthcare practitioners to adopt a comprehensive approach, from initial diagnosis to ongoing monitoring, to achieve optimal patient care. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04519-9.

Waardenburg Syndrome Type 2 in Paediatrics: A Case Highlighting Diagnostic Complexities and the Efficacy of Cochlear Implantation.

Waardenburg Syndrome Type 2 (WS2) is a rare hereditary condition with a low prevalence, characterized by abnormalities in both auditory function and pigmentation. We present a case of a 2-year-old female child who exhibited reduced vocalizations, delayed speech development, and distinctive heterochromic irides. Initial auditory assessments revealed bilateral severe to profound hearing loss. Subsequent MRI findings confirmed bilateral aplasia of the posterior semicircular canals, consistent with a diagnosis of Waardenburg syndrome type 2. While standard treatments using bilateral Behind-The-Ear (BTE) power hearing aids yielded only modest improvements, cochlear implantation significantly enhanced auditory perception and speech abilities within 18 months. This report underscores the diagnostic intricacies of WS2 and highlights the profound benefits of cochlear implantation in addressing associated auditory challenges.

Management of Rhinosporidiosis: by Coblation.

Rhinosporidiosis is a granulomatous disease commonly affecting the mucous membrane. It is caused by Rhinosporidium seeberi, an aquatic parasite & seen affecting the nose, paranasal sinuses most commonly. A retrospective study was conducted at a tertiary care hospital situated in Indian peninsula and five patients who were diagnosed and treated for rhinosporidiosis were analysed. Surgical excision by coblator along with medical management using Dapsone 100 mg once daily for 6 months given promising results in view of reducing recurrence. Combined approach of management including surgical excision using coblator and medical therapy with dapsone is effective in managing the rhinosporidiosis with no recurrence.

Hearing Aids and Quality of Life: A Psychological Perspective.

Objective: This research assessed the relationship between hearing aid usage and quality of life in individuals with hearing impairment, exploring associated demographic and clinical factors. Methodology: Data from 500 individuals at a tertiary care facility were collected over a year through medical records and an online questionnaire. Quality of life was gauged using WHOQOL-BREF and HHIE. Multiple linear regression analysed the correlation between hearing aid usage and quality of life, adjusting for age, gender, hearing loss severity, and socioeconomic factors. Results: Descriptive statistics showed varying degrees of hearing impairment, socioeconomic status, hearing aid usage, and quality-of-life scores. Bivariate analyses found significant correlations between hearing impairment level, socioeconomic status, hearing aid usage, and quality of life. Linear regression highlighted a positive relationship between daily hearing aid usage duration and quality-of-life scores, even after adjusting for covariates. Variations in quality-of-life ratings were observed between hearing aid users and non-users, spanning different hearing loss levels and socioeconomic statuses. Subgroup analysis showed a positive correlation between hearing aid use and quality of life across age groups. Conclusion: The study confirms the positive influence of hearing aids on the quality of life in hearing-impaired individuals, emphasizing the benefits of consistent use. Further studies should probe the specific domains and long-term adherence impacts. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04297-w.

Endoscopic Assisted Cold Steel adenoidectomy - A Cost Effective Modification for Better Outcome.

Introduction: Adenoidectomy is most commonly performed in children to alleviate the symptoms pertaining to adenoid hypertrophy. The conventional cold steel method utilizing adenoid curette is the most commonly performed method in the world even after the invention of endoscopes & powered instruments like coblator & microdebrider due to the cost & time factors. The conventional method being a blind procedure, carries higher rate of recurrence due to remnant tissues. The visualization of the adenoid tissue in nasopharynx through the nasal endoscope helps in better engagement of adenoids into the curette & adequate tissue clearance with reduced recurrence of symptoms. Aim: To study the effect of visualization of adenoid tissue for better tissue clearance in conventional adenoidectomy. Objectives: To compare the duration of surgery, blood loss & recurrence rate following conventional cold steel adenoidectomy (CSA) & endoscope assisted cold steel adenoidectomy (EACSA). Method: 50 patients who underwent adenoidectomy with various indications were grouped into two groups with 25 patients each. Group A underwent (CSA)with or without tonsillectomy & Group B underwent (EACSA) with or without tonsillectomy were followed up for the duration of 3 months. The patients were evaluated for duration of surgery & post operatively for the recurrence at 3rd month of follow up. Results: In our study, it was found that the tissue clearance in Group A was significantly low. The recurrence rate of 48% was observed in CSA group compared to 0% in group B with EACSA. The duration of surgery in both the procedures were comparable. Conclusion: EACSA is an effective modification to CSA. It adds the benefits of endoscopic visualization of adenoid for the conventional curettage. The high recurrence rates of CA can be effectively reduced with no significant variation in duration of surgery.

Outpatient Clinical Markers for Laryngopharyngeal Reflux Disease: A Correlational Study.

Laryngopharyngeal reflux disease (LPRD) is the result of retrograde flow of gastric contents to the laryngopharynx which comes in contact with tissues of the upper aerodigestive tract. Due to ill defined criteria for diagnosis & followup, LPRD patients are underdiagnosed & undertreated. Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) are two clinical methods which can be utilised especially in the outpatient setup. This study was done with the aim to assess various laryngoscopic findings in patients with LPRD diagnosed symptomatically and examine the correlation between the RSI & RFS by comparing these two indices. This prospective analytical study was conducted at a tertiary care centre in Bangalore in the Department of ENT for a period of 24 months between Dec 2020 to Dec 2022. The study included patients aged 18 to 60 years diagnosed with LPRD based on symptoms as per RSI score (> 13). RSI & RFS were assessed on diagnosis and patients were followed up for 1, 3 & 6 months for assessment. Total 96 patients were enrolled, with mean age of be 42.49 ± 11.33 years. Prevalence was found to be more in females (61.5%). The most common symptom according to RSI was frequent throat clearing & globus sensation (sensation of something sticking in throat) and most common finding according to RFS was erythema/hyperemia. The mean score of RSI and RFI was found to reduce with treatment at different intervals in follow-up visits. There was a significant strength of association between the RSI and RFS at baseline, 1st month, 3rd month and 6th month of follow-up (r = 0.568, r = 0.684, r = 0.774, r = 0.736 respectively) (p < 0.001).The RFS and RSI showed statistically significant strong relationships between total scores and sign and symptom characteristics. On follow-up, there was a significant reduction in the RSI which was also correlated with a reduction in RFS.

A Study on Comparison of Conventional Micro Laryngeal Micro Dissection Surgery with Carbon Dioxide Laser in Management of Benign Lesions of Larynx.

Dysphonia is a common symptom in benign and pre malignant lesions of larynx affecting vocal cords. Surgical excision is the main stay of treatment. Only a limited number of studies have compared the efficacy of microdissection versus CO2 laser surgery in the larynx. In the present study we have compared conventional micro-laryngeal surgery and carbon dioxide laser assisted microsurgical technique in the management of these lesions. A randomized prospective study was conducted in 88 cases of benign and pre malignant lesions affecting vocal cords were divided randomly to undergo surgery either by conventional micro dissection or CO2 laser assisted techniques in a tertiary care hospital. The groups were assessed through vocal cord morphological observation by videostroboscopy and subjective voice assessment parameters GRBAS score and VHI10 index preoperatively and 2 weeks and 3 months postoperatively by a panel of blinded viewers and listeners. Surgical and recovery times were compared between the two groups. Intraoperative blood loss was compared by gauze visual analogue. Patients recovered remarkably well following both the techniques as denoted by the voice parameters. Peroperative bleeding was observed to be significantly reduced in the laser excision group; operating time was significantly increased in this group. Duration of hospital stay was similar in both groups. No differences in clinical outcomes are identified when comparing microdissection with laser excision of benign lesions.

Can Nose Scale Be Used as a Predictor of Successful Surgery in Patients Undergoing Septoplasty.

The complaint of nasal obstruction or difficulty in nasal breathing is highly subjective. The benefits of surgery vary depending upon patient perception and satisfaction. Along with objective methods like nasal endoscopy improvement in subjective score of patients symptoms is definitely an important outcome parameter of management. Assessing the disease specific quality of life outcomes of patients undergoing septoplasty by means of a questionnaire using nose scale and correlating it with diagnostic nasal endoscopic findings and clinical examination thirty patients above 17 years of age, with anatomical deviation of the nasal septum as the sole cause of obstruction and symptoms persisting for more than 3 months, underwent septoplasty. Degree of septal deviation was classified as per Mladina classification. Patients Nasal Obstruction & Symptom Evaluation (NOSE) score were documented preoperatively and postoperatively and analysed. In our study it was found that there was significant improvement in nose scores which correlated with the improvement in nasal endoscopic findings. Use of NOSE score will help in letting the patient know his expected outcome following septoplasty and can be used as a predictor of successful surgery/an adjunct to clinical examination and nasal endoscopy in patients undergoing septoplasty. Disease specific health status instruments like Nose scale are needed along with objective outcome measures to compare disease-specific health status and symptom severity in patients before and after treatment. Similarly it could be used to assess differences in outcome when different surgical techniques are used. These subjective scales like nose scale can be used as along with to clinical examination and nasal endoscopy in the management of patients undergoing septoplasty.

An Unusual Case of Bilateral First Branchial Cleft Anomaly: A Case Report with Review of Literature.

We report a case of 32 year old male who presented to us with first branchial cleft anomalies on both sides with discharging cutaneous openings on the right side; and cystic swelling on the left side. High index of suspicion is required in such congenital cysts. Surgical exploration and excision is the definitive treatment of a collaural fistula.

A Study on Role of NOSE Scale in the Management of Allergic Rhinitis.

Allergic rhinitis is a global health problem and patients present with varied symptoms. The severity of symptoms is evaluated by a 5 point Nasal Obstruction Symptom Evaluation Scale (NOSE) and levels of absolute eosinophil count (AEC). A prospective observational study was conducted in 140 patients in a tertiary care hospital over a period of 1 year. A detailed clinical examination was performed, NOSE scale scoring based on symptomatology was done, and AEC values were assessed. Subjects were treated with intra nasal steroid spray and symptom evaluation done by NOSE scale at 3 months of use for follow up. NOSE scale and AEC values were correlated in our study. The mean NOSE 1 scale was 64.07 ± 16.71 in the study population, the mean AEC value was 633.07 ± 152.77. In our study correlation between intra nasal steroid spray and NOSE scale has been done. NOSE scale evaluation is simple, economical, and non-invasive. Therefore, it may be used in the management of allergic rhinitis.

Use of Bilateral Nasolabial Flaps with Coronoidectomy as a Novel Approach to a Case of Oral Cancer with Severe Trismus.

Patients with oral malignancy often have associated trismus. Trismus is a debilitating condition that needs to be treated adequately with the release of fibrosis and interposition of vascularized tissue to provide long-term improvement in the mouth opening. Treatment of oral cancer in patients with severe trismus becomes challenging because of difficult access and further deterioration of mouth opening following treatment of the malignancy. Herein, the planning of access to oral cancer and management of trismus in 9 oral cancer patients with severe trismus using nasolabial flaps and coronoidectomy are described. Bilateral nasolabial flaps and coronoidectomy were used successfully as an approach in these 9 patients with oral carcinoma with severe trismus. The advantages of this procedure are described.

Use of Clavien-Dindo Classification System in Assessing Head and Neck Surgery Complications.

Improving quality of postoperative surgical care in head and neck surgery requires reporting of complications. Clavien-Dindo classification system can be used in grading complications related to head and neck surgery and to assess interobserver variability in grading complex complication scenarios. Data was collected from 242 patients who underwent Head and Neck Surgery from 2015 to 2018 at Dept. of ENT and Head and Neck Surgery at a tertiary care hospital. 177 patients had complications were graded based on Clavien-Dindo classification system, into a 5-scale classification system. Interobserver reliability scores for the complication grading scenarios were found to be statistically significant. Construct validity was confirmed as the length of stay in the hospital was statistically related to complication grade (P = 0.032) Reporting of complications is critical to quality improvement in surgical practice. The Clavien-Dindo complication grading scale system was found to be a useful tool for grading head and neck surgery complications.

A Study of Application of Preoperative Clinical Predictors of Difficult Laryngeal Exposure for Microlaryngoscopy: The Laryngoscore in the Indian Population.

Good exposure for visualisation of the glottis is an essential prerequisite for effective microlaryngoscopy. There is no definitive clinical predictor scoring system to predict difficult microlaryngoscopy. The aim of the study was to study the validity of the Laryngoscore scoring system as a preoperative clinical predictor score in Indian population for difficult laryngeal exposure during microlaryngoscopy. A prospective study was carried out in 32 patients undergoing microlaryngoscopy in a tertiary care hospital who were evaluated by a standardized preoperative assessment protocol (Laryngoscore) which included 11 parameters interincisors gap, thyro-mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexion-extension, history of previous open-neck and/or radiotherapy, Mallampati's modified score, and body mass index. Each parameter was assessed to obtain a total score (Maximum-17). Patients were divided into five classes according to the anterior commissure visualization: class 0 to class IV. Class 0 being complete and class IV being impossible AC visualization. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94% of patients. Laryngoscore had a sensitivity of 87.5% and specificity of 75% in predicting difficult laryngeal exposure. The positive and negative predictive values of the same are 53.8% and 94.7% respectively. Our study found that the Laryngoscore scoring system as a preoperative indicator for predictor of Difficult Laryngeal Exposure during Micro Laryngeal surgeries is very useful in the Indian population.

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap.

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.