Giant Pleomorphic Adenoma of Infratemporal Fossa: A Rare Case Report.

Of all the head and neck tumors, salivary gland tumors account to 3%. Pleomorphic adenomas are one of the most common benign tumors arising from major salivary glands, although it could also develop from minor salivary glands situated at accessory sites like nasal cavity, pharynx, parapharyngeal space, lacrimal glands etc. Tumors of infratemporal fossa are quite unusual, mainly because of its hidden location in retromaxillary region. We report an unusual case of 65 years old male presenting with complaint of progressive left cheek swelling for 4 years. FNAC revealed pleomorphic adenoma of minor salivary gland tumor. Intraoperatively a giant lobulated tumor was seen occupying almost whole space of infratemporal fossa, which was removed in-toto via open approach. Patient was kept on regular follow up with no evidence of recurrence reported till date.

Quality of life and its determinants among hypertensive patients in a rural area of district Gautam Buddha Nagar, Uttar Pradesh - A community-based cross-sectional study.

Context: Hypertension is the leading cause of mortality and disability-adjusted life year (DALY) all over the world. World Health Organization defines quality of life (QOL) as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. Aims: The study was aimed to compare the the QOL of adult hypertensive patients with healthy study subjects and to determine the factors associated with poor QOL among the hypertensive subjects. Materials and Methods: A community-based cross-sectional study was conducted from January 2021 to June 2022 in Gautam Budh Nagar District. The study was carried out among 250 hypertensive patients and 50 healthy persons based on World Health Organization-Quality of Life-BREF questionnaire Manual. Statistical Analysis Used: Data collected were entered and statistically analyzed using statistical software (SPSS-22). Results: Overall QOL and general health scores were significantly lower among hypertensive subjects showing worsening of QOL among diseased persons (P value <0.001). Factors significantly associated with poor overall QOL were low educational status (P value <0.001), home makers (P value <0.001), lower socio-economic class (P value < 0.001), and subjects with co-morbidities (P value <0.001). Conclusion: The findings revealed that QOL was poor among the hypertensive subjects as compared to healthy subjects.

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120 dB which was improved to 13.387 ± 5.253 dB postoperatively at 12 weeks which was statistically significant. The mean postoperative ABG closure was 8.700 dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Evaluation of Pre and Post-operative Pulmonary Artery Pressures in Children with Adenotonsillar Hypertrophy and Correlation with Chronicity: A Prospective Study on 50 Children.

Children with grade III or IV of adenotonsillar hypertrophy especially of a longer duration, may show cardiovascular changes due to mouth breathing. These changes can be detected on doppler echocardiocardiography which can be used as a screening tool. Fifty paediatric patients of grade 3 and 4 adenotonsillar hypertrophy underwent adenotonsillar resection after a pre-operative work up which included doppler echocardiography to measure pulmonary artery pressures. A post-operative doppler echocardiography was done after three months. 11 children (22%) showed deranged pulmonary artery pressure values with increased mean pulmonary artery pressure (MPAP) and pulmonary artery systolic pressure (PSAP) on preoperative doppler echocardiography, and 2 out of these 11 children had Pulmonary Artery Hypertension. A significant (p < 0.001) improvement was noted in pulmonary artery pressure values (MPAP and PSAP returned to normal) after adenotonsillectomy in 3-month postoperative echocardiography. Also, a statistically significant correlation was obtained between chronicity of symptoms and raised pulmonary artery pressures. Our study concluded that these children with chronic untreated upper airway obstructive symptoms get predisposed to potential cardiac complications. And these grave consequences can be easily prevented by a timely intervention.

Prevalence of Ear Disease and Associated Hearing Loss Among Government Rural Primary School Students in Patiala, Punjab: A Cross Sectional Survey.

Ear disease in children are a major public health problem in developing countries and if left untreated, it may result in various social and psychological problems for affected children. Among all ear diseases, ear infections are a common but treatable cause of morbidity in children. Long term consequences of persistent severe ear infection can result in speech development disorders, poor academic and educational development and overall lower quality of life. Most of ear diseases leading to hearing loss are preventable if diagnosed and treated early. A cross sectional study was conducted in Government Rural Primary School students, 2160 students in Patiala district of Punjab state in India with aim to study the prevalence of ear disease and associated hearing loss in students and their relationship with socioeconomic status. The data was collected, compiled and analysed statistically.

Association Between Metabolic Syndrome and Hearing Impairment: a Study on 200 Subjects.

The metabolic syndrome (MS) is a cluster of conditions that occur. togehther, increase risk of heart disease, storke, type 2 diabetes mellitus and hypertension as a possible outcome. The previous research has shown a link between hearing loss and being overweight, diabetic, or suffering from heart disease. However, research on the possible link between hearing loss and metabolic syndrome is limited. Hearing loss due to metabolic syndrome was evaluated in the present investigation. Two hundred individuals with metabolic syndrome were included. All the patients were evaluated on three types of audiometry (pure tone, impedence, and DPOAE).Anthropometric data, blood pressure, blood sugar, and lipid profiles, were all collected from each patient. We also asked about their smoking and drinking habits in the past. SPSS v. 22.0 was used to conduct the statistical analysis. Overall, SNHL affected 58.5% of patients. Patients having moderate hearing loss were the largest demographic group (40%), followed by those with mild hearing loss (15% ). Severe hearing loss only occurred in 3.5% of patients. Hearing loss was shown to be more prevalent in patients with more than three components of metabolic syndrome. Significant associations were found between hearing impairment and metabolic risk factors as waist circumference, fasting blood sugar, serum high-density lipoprotein, serum triglycerides, and systolic and diastolic blood pressure. Hearing loss was only marginally connected to smoking and excessive drinking.

Application of an optimal tilt controller in a partial loading schedule of multi-area power system considering HVDC link and virtual inertia.

Maintaining the reliability of the modern power system is becoming increasingly challenging due to the continuous growth in its size and complexity. One of the most significant challenges PS faces is frequency regulation, which is essential for maintaining a stable and reliable operation of PS. This article investigates the automatic generation control (AGC) of a multi-area PS considering partial loading scheduled in a hydro and thermal generating unit. A bird swarm algorithm (BSA) based two-degree of freedom tilt integral derivative (2DOF-TID) controller has been suggested. The superiority of the optimal 2DOF-TID controller has been selected by comparing the system dynamics with other conventional controllers. Also, the ascendancy of suggested BSA has been shown over the grasshopper algorithm and particle swarm optimization techniques. The investigation on partial loading schedules for the hydro-thermal system showed that the system's dynamic response deteriorates when loading on hydro units exceeds their nominal loading. Also, system dynamics are enhanced when thermal units are loaded beyond their capacity. The investigations are also conducted to analyse the effect of high voltage direct current (HVDC) link and virtual inertia emulation with an energy storage system. The studies with alternating current (AC)/HVDC and virtual inertia revealed that dynamic responses are better with the latter when compared with AC and HVDC links alone.

Temporal Bone Osteomyelitis Masquerading as Malignancy: A Diagnostic Challenge.

Xanthogranulomatous osteomyelitis is a rare chronic inflammatory disorder. Until now, it has only been reported in long bones. To the best of our knowledge, it has never been reported in temporal bone. We present the case of this rare disease in a 64-year-old male involving the temporal bone, presenting with ear pain, discharge, decreased hearing, and granulation tissue in the external auditory canal, mimicking malignancy clinically and radiologically. The patient was unresponsive to medical management and was taken up for surgical debridement, followed by treatment with systemic and topical antibiotics, with a successful outcome. As this disease has not been reported in the literature yet in the temporal bone and mimics malignancy, it must be differentiated on histopathology to establish a definite diagnosis and provide appropriate management. A long-term follow-up is also necessary to recognize the clinical behavior of this disease, as no treatment protocol has been established yet.

Surgical Outcomes of Type 1 Tympanoplasty in Chronic Otitis Media in Paediatric Patients: A Prospective Study.

Objectives: To observe the surgical outcome of type 1 tympanoplasty in paediatric patients in the form of graft uptake and audiological improvement. Materials and methods: A prospective study was done in which 40 paediatric patients in age group 6-16 years, diagnosed of chronic otitis media, were taken up for tympanoplasty under general anaesthesia. Patients were followed in post operative period at 4, 6 and 12 weeks for assessment of graft status and audiological evaluation. Results: In this study, we found surgical success rate in the form of graft uptake in 80% of the cases and audiological improvement in 75% of the cases. Conclusion: Tympanoplasty is safe and effective in children with adequate graft uptake and audiological outcome. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03965-1.

A Case Report of Chondromyxoid Fibroma of the Nasal Cavity.

The chondromyxoid fibroma is a benign osseocartilaginous tumor histopathologically characterized by chondroid, fibrous, and myxoid tissues (Nazeer et al. in Skeltal Radiol 25:779-78, 1996). Its occurrence is quite rare, accounting for less than 0.5% of all bone tumors, with 1-5% of cases reported in the head and neck region. We report an unusual case of 25 years old male who presented with progressive swelling over dorsum of nose with bilateral nasal obstruction over 1 year. The histopathological examination was suggestive of chondromyxoid fibroma. The tumor was completely excised via open approach. We report this case owing to the rarity of the disease, sometimes masquerading as invasive/malignant pathology.

A Rare Presentation of Thyroid Mass as Tubercular Abscess: A Case Report.

Isolated thyroid gland tuberculosis is a rare disease, while even rarer is its presentation as an acute abscess. Here we present the case of a 65-year-old female who presented with a neck swelling which progressed to an abscess with multiple discharging sinuses which was proven to be tubercular abscess on histopathology.

Effect of Chronic Suppurative Otitis Media on Gustatory Function of chorda Tympani Nerve : A Prospective Study.

Introduction the ability to taste is among the life's finest pleasures and perception of taste can be altered by various disorders or therapeutic regimens as colds or dental procedures. Head trauma patients, patients on certain drugs such as phenylbutanone, carbamazepine and baclofen and patients with inflammatory diseases of the middle ear frequently complain about alterations in their ability to taste. So, assessment of gustatory sensitivity is the prerequisite for the correct diagnosis of taste dysfunction which uses taste strips impregnated with taste stimulants. Material and method in this prospective study, 40 patients were enrolled after assessment of history, general and local examination of ear and finally assessment of gustatory function was done according to Muller technique using taste strips. Results in present study out of 40 patients, 16 (40%) patients had COM squamous, 24 patients (60%) had COM mucosal. In the ipsilateral diseased ear (both COM squamous & mucosal) the mean taste score for various taste sensation was 11.65 ± 2.59. In the contralateral normal ear, the mean taste score was 15.42 ± 0.78. The difference between the two was found to be statistically significant (p < 0.0001). Conclusion a significant difference was obtained in taste scores between diseased (ipsilateral) and normal (contralateral) ears both overall and also when subtypes were compared. Thus, the present prospective study indicates that COM squamous as well as mucosal can induce taste dysfunction. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03703-7.

Post-Covid Isolated Mandibular Mucormycosis in a Patient with Chronic Kidney Disease: A Case Report.

Mucormycosis is an opportunistic fungal infection which was earlier seen only in immunocompromised patients. With the recent covid pandemic, there had been a drastic surge in cases of mucormycosis worldwide and especially in India. Here, we present an unusual case of biopsy proven invasive mandibular mucormycosis in a patient with chronic kidney disease and a history of COVID-19 infection. The patient was given low-dose amphotericin B and underwent surgical debridement with a successful outcome.

Endoscopic Push-Through Cartilage Myringoplasty for Anterior Perforations.

Introduction: The study aims to evaluate the anatomical and functional success rates of endoscopic push-through cartilage myringoplasty for anterior tympanic membrane (TM) perforations. Materials and Methods: Thirty patients with TM perforations in the anterior quadrant underwent endoscopic push-through cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated. Results: Out of the 30 patients, 15 were male, and 15 were female. The mean age was 32.60 ± 13.66 years (from 18-60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 37.9 ± 5.83 dB which improved to 27.66 ± 4.88 dB at 16 weeks post-operation. The mean postoperative ABG closure was 7.28 dB with a p-value of 0.001 which was statistically significant. Conclusions: Endoscopic push-through cartilage myringoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration.

Comparative Effectiveness Research: Betahistine add-on Therapy with Epley's Manoeuvre Versus Epley's Manoeuvre Alone in Treating Posterior BPPV Patients.

INTRODUCTION: Benign paroxysmal positional vertigo is one of the common vestibular disorders encountered in ENT clinics with accompanying vertigo. Study to evaluate the additive effects of betahistine on Epley's manoeuvre in treating posterior BPPV patients. MATERIAL AND METHODS: Prospective study was conducted on 50 patients of posterior BPPV diagnosed by the Dix Hallpike test. Subjects were divided into Group A which received the Betahistine therapy along with the canalith repositioning technique (Epley's manoeuvre) and the second group (Group B) which received the Epley's manoeuvre alone. The patients were assessed at 1 week and 4 weeks by Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). RESULTS: At the end of 4 weeks, 2 patients in group A (E + B) had positive Dix-Hallpike and 23(92%) had negative Dix-Hallpike, while 11 patients in group B (E) had positive Dix-Hallpike and 14 (56%) had negative Dix-Hallpike with P value < 0.001. The Mean baseline (T0) Visual Analogue Scale (VAS) score in group A (E + B) was 8.60 ± 1.080 and in group B (E) was 8.92 ± 0.996. Post-treatment VAS score was significantly lower in both the groups and was significantly lower in group A(E + B) than in group B (E) (0.680 ± 1.930 vs. 3.96 ± 3.587, respectively, p-value < 0.001). The Mean baseline (T0) Dizziness Handicap Inventory (DHI) scores were similar in groups A and B (77.36 ± 9.49 vs. 80.00 ± 8.9, respectively, p = 0.271). After treatment, the DHI values were significantly lower in both groups. Group A had a better DHI score than group B (10.56 ± 17.12 vs. 44.72 ± 27.35, p < 0.001). The mean baseline (T0) Short Form 36 (SF-36) scores were also similar in groups A and B (19.53 ± 6.85 vs. 18.79 ± 5.50, p = 0.823). Post-treatment of 4 weeks, the SF-36 score significantly improved in both the groups and significantly improved in group A than group B (84.27 ± 17.28 vs. 46.53 ± 24.53, p < 0.001). CONCLUSION: Betahistine therapy in conjunction with Epley's manoeuvre leads to better symptom control and is more effective than Epley's alone in treating BPPV patients.

Hearing Assessment in Patients of Allergic Rhinitis: A Study on 200 Subjects.

Allergic rhinitis (AR) is a type I hypersensitivity reaction of the nasal mucosa, primarily mediated by IgE, with a complex etiology, determined by genetic and environmental interactions. Several mechanisms by which AR affect middle ear and cause conductive hearing loss have been well described. There is paucity of data regarding involvement of inner ear in AR patients leading to sensorineural hearing loss. However, endolymphatic sac and outer hair cells have been hypothesized to be the seat of immunoreactivity. To study the audiological profile in AR and effect of AR on inner ear functions. 100 cases of AR patients (55 males, 45 females, mean age group 21-30 years) and 100 controls (65 males, 35 females, mean age group 41-50 years) were enrolled in study. All underwent thorough clinical ear, nose and throat examination, diagnostic nasal endoscopy and otoendoscopy, followed by audiological assessment including pure tone audiometry, tympanometry and oto-acoustic emission test. Hearing results of both the groups were compared and analysed statistically. Thirty two patients among case group had sensorineural hearing loss, pronounced at 4000 and 8000 Hz frequencies. 18 patients showed conductive hearing loss in the form of type B or type C tympanogram. 32 patients of AR patients showed unusual oto-acoustic emission test. We found higher prevalence of high frequency sensorineural hearing loss in pure tone audiometry and abnormal OAEs in patients having upper airway allergy. The likely seat of damage appears to be the inner ear as evidenced by recordings of OAE in allergic patients.

Smartphone Applications for Otolaryngology: Head and Neck Surgery-A Recent Update.

Rise in the number of smartphone users have led to an increased development of smartphone applications. Advent of technology and increased awareness has led to an increased use of healthcare apps by both the physicians and patients. This study aims to provide an up to date review on applications related to Otolaryngology, head and neck surgery (Oto-HNS). The smartphone applications were reviewed in May 2020 in Google play store and apple app store using relevant search words. We included apps relevant for physicians, students as well as patients. Apps providing alternative therapies and home remedies were excluded. A total of 619 apps were included with 352 apps from play store and 267 apps from apple store. Number of apps have remarkably increased in the last 2 years till May 2020, 63 apps were developed and last year 141 Oto-HNS apps were developed. Maximum number of apps were available in hearing aid category with 144 (23.2%) mobile hearing aids and 138 (22.2%) hearing aid control apps. 445 apps were available free of cost. Use of smartphone apps have increased dramatically in the last few years. However, their authenticity is still uncertain. Actual involvement of Otolaryngologist in app development is still rare. We recommend formation of scientific committees to regulate the apps development, to access apps quality and effectiveness before incorporated in clinical practice, medical education and patients use.

Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Tertiary Care Institute Experience in India.

COVID-19 epidemic has varied spectrum of symptoms. With this study we aim to evaluate prevalence of Olfactory and Gustatory dysfunction in COVID-19 patients. To assess Olfactory and Gustatory dysfunction in COVID-19 Patients in Indian Population. Settings and Design: Prospective observational study. RT-PCR proven COVID-19 patients were enrolled in the study. Detailed history and olfactory function and Taste function were evaluated. Patient with symptoms of olfactory dysfunction were subjected to fill (sQOD-NS questionnaire). Re-evaluation was done weekly till the time of discharge. Analysis was done with Wilcoxon test with help of SPSS software. A total of 152 patients (Male-78, Female-74) completed the study after weekly evaluation. Olfactory and Gustatory dysfunction was seen in 28 (18.41%) and 20 (13.15%). Mean duration of symptoms was 2.4444 ± 0.352 days. Olfactory dysfunction was the first presenting symptom in 11 out of 152 patients (7.23%). Mean QD-NOS score in patients with Anosmia and Hyposmia (28 patients) was 11.4 ± 2.01 and 13.61 ± 2.82 at 1st evaluation, 20.3 ± 1.49 and 20.33 ± 1.57 at 7th day and 21 in both subgroups at 14th day follow up. Dysgeusia was noticed in 20/152 patients (13.15%). Recovery in olfactory dysfunction and Dysgeusia was complete in all patients. Olfactory and gustatory dysfunctions are significant part of clinical spectrum of COVID-19 disease In Indian Population.

Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study.

To evaluate ototoxicity in patients receiving combined cisplatin and radiotherapy in comparison to patients receiving radiotherapy alone. A prospective study was conducted in sixty (60) cases of advanced Head and Neck malignancy (stage III and IV). Patient were divided in two randomized groups (30 each), group I received chemoradiation and group II received radiation alone. Inclusion criteria were histopathologically confirmed head & neck malignancy, normal baseline audiograms. Exclusion criteria were defined as: previously treated cases with chemotherapy/radiotherapy, patients who didn't complete treatment or lost to follow up. Ototoxicity was evaluated as per criterion established by the American speech-language-hearing association. Study participants were evaluated for ototoxicity at intervals defined as per study design. Sensorineural hearing loss (SNHL) was noticed in 56.6% and 36.6% of subjects in Group I & II respectively at 6 months follow up post completion of treatment. Incidence of sensorineural hearing loss increased significantly with cumulative dosages of chemoradiotherapy in group I and radiotherapy in group II. Incidence of SNHL in both study groups was found to be higher in patients older than 50 years. Incidence of ototoxicity in chemoradiated patients was found to be higher in comparison to patients receiving radiation alone. Ototoxicity occurred more with cumulative doses, with higher speech frequencies affected earlier in comparison to middle range frequencies. Lower frequencies were spared.

Intratemporal Facial Nerve Anatomy and its Variations in 30 Cases of Cadaveric Temporal Bones.

It is important for the ENT surgeon to be familiar with the anatomy of the facial nerve and to prevent iatrogenic injury to nerve as it shows variations in its intratemporal course. Present study was done to delineate the intratemporal course of facial nerve and observe its variations. Thirty wet cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of Otorhinolaryngology and Head Neck Surgery, Government Medical College, Patiala. The length of intratemporal segments of facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variations in its course were observed. The mean length of labyrinthine, tympanic and mastoid segment was found to be 4.28 ± 0.605 mm, 10.40 ± 1.416 mm and 12.34 ± 0.915 mm respectively in the dissected specimens. The first and second genu angle varied between 50°-90° and 90°-120° respectively. Facial canal dehiscence was present at the level of first genu in 10% of cases and at the level of tympanic segment in 33%. Distance between chorda tympani origin and stylomastoid foramen varied between 4 and 6 mm with mean value of 5.31 ± 0.603 mm. Chorda-facial angle was found to be in the range of 20° to 31° with mean of 25.30° ± 2.90°. The tympanomastoid segment of facial nerve has variations in length and in its relations with various middle ear structures. The facial canal, as it traverses the temporal bone, may display bony dehiscence, variations, and anomalies in its natural course, having its own clinical and surgical significance.