A Comprehensive Review on Biofilms in Otorhinolaryngology: Understanding the Pathogenesis, Diagnosis, and Treatment Strategies.

Biofilms, structured communities of microorganisms encased in a self-produced matrix, pose significant challenges in otorhinolaryngology due to their role in chronic and recurrent infections affecting the ear, nose, and throat (ENT) region. This review provides an overview of biofilms, emphasizing their formation, pathogenesis, diagnosis, and treatment strategies in otorhinolaryngological disorders. Biofilms are pivotal in chronic rhinosinusitis (CRS), otitis media, laryngopharyngeal reflux (LPR), and tonsillitis, contributing to treatment resistance and disease recurrence. Current diagnostic techniques, including imaging modalities, microbiological cultures, and molecular techniques, are discussed, alongside emerging technologies. Treatment strategies, ranging from conventional antibiotics to alternative therapies, such as biofilm disruptors, phage therapy, and immunomodulation, are evaluated in terms of their efficacy and potential clinical applications. The review underscores the significance of understanding biofilms in otorhinolaryngology and highlights the need for tailored approaches to diagnosis and management to improve patient outcomes.

A Comprehensive Review Exploring Allergic Rhinitis With Nasal Polyps: Mechanisms, Management, and Emerging Therapies.

Allergic rhinitis (AR) and nasal polyps (NP) are common inflammatory disorders of the upper airways that often coexist and significantly impact patients' quality of life. This comprehensive review explores the intricate relationship between AR and NP, elucidating the underlying mechanisms, clinical manifestations, and management strategies. Immunological mechanisms, genetic predispositions, and environmental factors contribute to the development and progression of both conditions. Pharmacological therapies, including intranasal corticosteroids and biologic agents, are cornerstone treatments for managing AR with NP. At the same time, surgical interventions such as functional endoscopic sinus surgery (FESS) may be necessary in refractory cases. Emerging therapies, including immunomodulatory agents and precision medicine approaches, hold promise in improving treatment outcomes. A multidisciplinary approach, personalized treatment plans, and patient education are essential for optimizing clinical practice. Future research should focus on identifying novel therapeutic targets, conducting large-scale clinical trials, exploring precision medicine approaches, and investigating the role of the microbiome. Addressing these research priorities and implementing evidence-based treatment strategies can improve outcomes for patients with AR and NP.

A Facial Solitary Vellus Hair Cyst: A Rare Entity.

This case report details a rare occurrence of a vellus hair cyst presenting as a recurrent nodular swelling on the medial aspect of the right eye in a 23-year-old male. The patient underwent surgical excision guided by imaging studies, and the subsequent two-month follow-up revealed no signs of recurrence. Imaging, including contrast-enhanced computer tomography (CECT), played a crucial role in assessing the extent of the lesion and ruling out intracranial involvement. Histopathological examination confirmed the diagnosis, revealing cystic spaces with an attenuated lining containing vellus hair and marked fibrosis. The case underscores the importance of considering uncommon entities in differential diagnoses, emphasizes the efficacy of complete cyst removal in preventing recurrence, and contributes to the evolving understanding of vellus hair cysts. Further research is warranted to enhance our knowledge of their epidemiology and optimal management strategies.

Pattern and Severity of Allergic Rhinitis Correlated with Patient Characteristics: A Rural Hospital-Based Cross-Sectional Study.

Allergic Rhinitis (AR) is rising in incidence in both developed and developing countries. Genetics and epigenetics have a potential role to play. The pattern and severity of AR have implications with regard to choice of treatment, which itself could be related to patient specific genetic and epigenetic factors. Hence, the present study was undertaken to correlate the patient characteristics with AR pattern and severity, in order to understand the pathophysiology of AR. The study also aimed to find out the allergen sensitivity pattern among patients attending a tertiary care centre of rural central India, where climatic variations make it a high prevalence zone. Prospective Observational study on 90 patients with clinically diagnosed Allergic Rhinitis confirmed by Skin Prick Tests. Patient characteristics like demographic data, data relevant to allergen exposure, occupation, family history of atopy and gender; and Disease characteristics like severity (mild, mod-severe), pattern (continuous/ intermittent), type of disease (seasonal/perennial) were noted, analysed and correlation studied. Majority of the patients with AR were in the age group of 15-40 years. Medical students (52%) suffered from moderate to severe type of Allergic Rhinitis, with Persistent disease in approximately 80%. Similarly, 70.59% of farmers had moderate to severe type of the disease, with persistent disease in 70%. In the present study, in clinically diagnosed allergic rhinitis patients, Mite was the commonest allergen found on Skin Prick Test overall and in Medical students, whereas Pollen sensitivity was more common among farmers. 56.66% of the patients had negative family history of atopy. Severity and type of AR depend on allergen exposure. In farmers and medical professionals, persistent and moderate to severe type of disease was more common, as they were persistently exposed to different type of allergens, mites in case of medical professionals and pollens in farmers. Hence, the Disease characteristics, as defined by ARIA guidelines, should not be taken in isolation and management should consider the Patient characteristics for deciding and devising protocols. In the present study, more than 50% patients were without family history of atopy. Hence, the role of various environmental factors, leading to epigenetic changes could be a major contributor in the increase in incidence of allergic rhinitis in recent times. Occurrence of perennial moderate to severe form of disease, in majority of farmers, defies the phenomenon of "Hygiene Hypothesis", focusing on the role of epigenetic changes and various outdoor allergens in the development of allergic rhinitis in them.

Inverted Papilloma From Nasal Septum: A Rare Case Presentation.

Inverted sinonasal papillomas, also referred to as Schneiderian papillomas, are benign tumors originating from the Schneiderian membrane that lines the nasal cavity and paranasal sinuses. They frequently display an endophytic growth pattern, in which the stroma beneath is invaded by epithelial cells. The exact cause of inverted sinonasal papillomas is unknown, but several theories have been offered. The most widely accepted theory states that these tumours arise from the metaplasia of the respiratory epithelium into a stratified squamous epithelium. This metaplastic process is thought to be brought on by irritant exposure, chronic inflammation, or viral infections like the human papillomavirus (HPV). While inverted sinonasal papillomas commonly arise from the paranasal sinuses and lateral walls of the nasal cavity, their occurrence from the nasal septum is relatively rare. Additionally, although inverted sinonasal papillomas are typically benign, they can exhibit locally aggressive behaviour and damage nearby structures. The histopathological examination revealed nuclear atypia, which raises questions about the potential for malignant transformation. We describe a rare case of an inverted sinonasal papilloma that developed from the nasal septum. The tumour spread into the septum's anterior cartilaginous region, causing the cartilage to deteriorate and develop mucosal defects. The rarity of an inverted sinonasal papilloma arising from the nasal septum along with its impact on cartilaginous septum is discussed. Careful monitoring and prolonged follow-up are therefore necessary to spot any signs of recurrence or malignant changes.

Vitamin E Supplementation and Cardiovascular Health: A Comprehensive Review.

This article conducts a thorough investigation into the potential role of vitamin E in preventing cardiovascular diseases (CVDs) in the context of shifting mortality patterns from infectious diseases to the continued prominence of CVDs in modern medicine. The primary focus is on vitamin E's antioxidant properties and its specific ability to counter lipid peroxidation, a pivotal process in the early stages of atherosclerosis, a precursor to CVDs. The research spans a wide range of methodologies, including in vitro, in vivo, clinical, and experimental studies, examining how vitamin E affects critical aspects of cardiovascular health, such as signaling pathways, gene expression, inflammation, and cholesterol metabolism. It also explores vitamin E's influence on complex processes like smooth muscle cell development, oxidative stress reduction, foam cell formation, and the stability of atherosclerotic plaques. In the context of clinical studies, the article presents findings that both support and yield inconclusive results regarding the impact of vitamin E supplementation on CVDs. It acknowledges the intricate interplay of factors such as patient selection, pathophysiological conditions, and genetic variations, all of which can significantly influence the efficacy of vitamin E. The article underscores the need for ongoing research, with a specific focus on understanding the regulatory metabolites of vitamin E and their roles in modulating cellular processes relevant to CVDs. It highlights the potential for innovative therapeutic approaches based on a deeper comprehension of vitamin E's multifaceted effects. However, it also candidly addresses the challenges of translating clinical trial findings into practical applications and emphasizes the importance of considering diverse variables to optimize therapeutic outcomes. In summary, this meticulously conducted study provides a comprehensive examination of vitamin E's potential as a preventive agent against CVDs, recognizing the complexity of the subject and the need for continued research to unlock its full potential in cardiovascular health.

Tonsillitis and Sinusitis: A Narrative Review of Pathogenesis, Diagnosis, and Management.

The review aims for a comprehensive examination of tonsillitis and sinusitis, covering their pathophysiology, diagnosis, and management, with a focus on recent breakthroughs and therapeutic practices. Tonsillitis, marked by inflammation of the tonsils, can result from viral or bacterial infections, particularly Streptococcus pyogenes, with attention to antibiotic resistance trends. This review discusses clinical manifestations, diagnostic criteria, and the importance of distinguishing viral from bacterial causes. Therapeutic interventions like antibiotics and tonsillectomy indications are evaluated within evolving guidelines. Regarding sinusitis, it explores its origins, contributing factors, and classification based on duration and pathophysiology. Viral infections, allergens, and structural anomalies' roles in pathogenesis are highlighted. Diagnostic modalities like imaging and endoscopic exams are assessed for their efficacy in guiding management decisions. The importance of precise diagnosis through clinical examination, microbiological testing, and imaging is emphasized for informed treatment choices. This review also delves into minimally invasive surgical procedures, particularly endoscopic sinus surgery and tonsillectomy, showcasing progress in these areas. In summary, it provides insights into tonsillitis and sinusitis, offering perspectives on their aetiology, diagnosis, and treatment while integrating current research and clinical standards to enhance patient care and healthcare resource utilization.

Obstructive Sleep Apnea in Adults and Ear, Nose, and Throat (ENT) Health: A Narrative Review.

Obstructive sleep apnea (OSA), a form of sleep-disordered breathing, is a significant health concern that leads to substantial morbidity. The collapse or occlusion of the upper airway, which results in reduced or cessation of airflow, is the pathophysiology of sleep apnea. The condition has been attributed to numerous cardiovascular, metabolic, and neuropsychological issues and carries serious health concerns. The ensuing intermittent hypoxia and sleep disruption set off a chain of physiological reactions that aid in developing endothelial dysfunction, systemic inflammation, and oxidative stress. The following line of treatment depends on the appropriate diagnosis of sleep apnea and the underlying cause. The gold standard for diagnosis is polysomnography (PSG), which assesses different physiological parameters during sleep. However, because polysomnography is expensive, patients may use more friendly screening and diagnostic testing kits, like home sleep apnea testing. The clinical symptoms and head and neck history may reveal essential risk factors. The primary objectives of management treatments for sleep apnea are to lessen symptoms, enhance sleep quality, and reduce any health concerns that may be present. It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. The primary treatment for moderate to severe sleep apnea is continuous positive airway pressure (CPAP) therapy, which includes administering pressurized air to keep the airway open while you sleep. Oral appliances, positional therapy, surgery, and complementary therapies are other treatment choices that can be adapted to each patient's needs and preferences. The goal of the review is to evaluate the morphological and functional aspects of the upper airway, including the nose and throat, that influence the onset and severity of OSA. With a focus on the interaction between otorhinolaryngologists, sleep medicine specialists, and other healthcare professionals, we aim to consider how OSA affects otorhinolaryngology-related medical issues, look at any potential reciprocal relationships, and provide a summary of the interdisciplinary management strategy for OSA. We tried to analyse the various surgical and non-surgical therapy options for OSA management available in the otorhinolaryngology field for improving OSA symptoms and results.

A Rare Association of Pituitary Macroadenoma With Nasopharyngeal Angiofibroma: A Case Report.

Pituitary macroadenoma and angiofibroma are two distinct and diverse types of tumors that can develop in different anatomical locations and clinical characteristics and are not typically related to each other in terms of their hormonal or developmental aspects. This case describes an adult male with pituitary macroadenoma with nasal angiofibroma. A 35-year-old male was diagnosed with pituitary macroadenoma and incidentally found to have juvenile nasopharyngeal angiofibroma (NPA). The patient underwent a diagnostic workup, including imaging studies and hormonal assays, which confirmed the concomitant presence of both tumors. The patient underwent successful endoscopic surgical excision of the NPA and transnasal transsphenoidal endoscopic pituitary macroadenoma excision as a two-stage operation. The patient was followed up postoperatively and had no evidence of tumor recurrence or hormonal imbalances. The importance of complete and comprehensive diagnostic workup and multidisciplinary management in achieving successful and optimum treatment outcomes for coexisting NPA and pituitary macroadenoma in an adult patient is highlighted in the present report.

Chronic Suppurative Otitis Media: A Comprehensive Review of Epidemiology, Pathogenesis, Microbiology, and Complications.

Otitis media is a significant contributor to healthcare visits and the prescription of drugs. Its associated complications and consequences pose the primary factors for preventable hearing impairment, especially in developing nations. Chronic suppurative otitis media (CSOM) is prevalent among children globally as one of the commonest chronic infectious diseases during childhood. The subsequent complications and sequelae play a central role in causing avoidable hearing loss, particularly within developing countries. In addition to impaired hearing, this condition can lead to severe health complications, such as issues involving the intracranial region. Despite the involvement of microbial, immunological, and genetic factors as well as Eustachian tube characteristics, in the development of CSOM, there remains a need for further elucidation regarding its pathogenesis. Based on its microorganisms, the treatment of choice will be affected to prevent further complications in the child. The primary approach to treating acute otitis media (AOM) involves effectively addressing ear pain and fever symptoms, while antibiotics are only administered in cases where children experience severe, long-lasting, or frequent infections. Despite the extensive investigation on AOM pathogenesis, research is scarce regarding CSOM. Given that antibiotic resistance and drug-induced ear damage are growing problems and surgery-related complications, it is imperative to devise effective therapeutic interventions against CSOM arises. Therefore, comprehending the host's immune function concerning CSOM and identifying how bacteria sidestep these potent responses becomes crucial. Acquiring insight into molecular mechanisms associated with CSOM will enable scientists to formulate innovative treatment approaches to combat this disease, thereby averting hearing loss consequences. The management consists of watchful waiting, primarily for children with chronic effusions and hearing loss.

Obstructive Sleep Apnea and Its Management: A Narrative Review.

Obstructive sleep apnea (OSA) is a disorder in which there is repeated collapse of the upper airway when the person is in sleep, which causes oxygen desaturation and interrupted sleep. While asleep, airway blockages and collapse are accompanied by awakenings with or without oxygen desaturation. OSA is a prevalent disorder, especially in people with known risk factors and other illnesses. Pathogenesis is variable, and the risk factors include low chest volume, erratic respiratory regulation, and muscular dysfunction in the upper airway dilators. The high-risk factors include overweight, male sex, aging, adenotonsillar hypertrophy, interruption of the menstrual cycle, preservation of liquids, and smoking. The signs are snoring, drowsiness, and apneas. A sleep history, assessment of symptoms, and physical examination are all part of the screening process for OSA, and the data can help determine which people need to be tested for the condition. The results of the polysomnogram or at-home sleep apnea test assist in determining the presence and severity of OSA. Still, it is seen many times that the accuracy of home sleep apnea tests is significantly less, so one should take an expert opinion for the same. OSA results in systemic hypertension, drowsiness, and driving accidents. It is additionally related to diabetes mellitus, congestive heart failure (CHF), cerebral infarction, and myocardial infarction, but the exact mechanism is not known. The preferred treatment is continuous positive airway pressure with 60-70% adherence. Other management options include reducing weight, therapy of oral appliances, and correcting any anatomical obstruction (narrow pharyngeal airway, adenoid hypertrophy, and mass in the pharynx). OSA indirectly causes headaches just after awakening and daytime sleepiness. However, there are no age boundaries in OSA as it can occur in any age group. Still, more prevalence is seen in individuals of more than 60 years of age.

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

INTRODUCTION: Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. METHODS: A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. RESULTS: Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. CONCLUSION: The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium." Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.

Association Between Anterior Rhinoscopic/Endoscopic Assessment of Internal Nasal Valve and Various Nasal Deformities in the Rural Population of Vidarbha Region of India: A Cross-Sectional Study.

Background The nasal valves constitute the majority of the nasal cavity's resistance. Any reduction in this already narrow area can cause a significant reduction in the nasal airflow. In this present study, the aim was to do an endoscopic assessment of the internal nasal valve (INV) in patients with various nasal septal deviations, with or without external nasal deformity. We measured endoscopically the INV in various nasal deformities and derived its association with the INV on anterior rhinoscopy and endoscopic assessment. Method  We included 75 patients in the study who were analyzed for angle and grade of the INV by anterior rhinoscopic examination and Hopkins rod zero-degree nasal endoscope (Karl Storz SE & Co., Tuttlingen, Germany). Nasal septal deviations were also studied with respect to the Mladina classification. Correlation between various nasal septal deviations with the INV was done. Since studies addressing the classification of INV are not available in the literature, for the purpose of simplification of observation of INV angle, (normal range 9-15 degrees), subjective stratification was made in the study, i.e. below 9, 9-15, and more than 15 degrees for the sake of knowing the underlying cause and its relationship. Result An anterior rhinoscopic examination was performed on 75 patients. INV Grade 1 was the most common, with 18 patients of (69.2%), 15 patients of DNS with caudal dislocation (55.6%), five patients of DNS with spur (38.5%), and four patients of DNS with external nasal deformity (50%). The next frequently observed Grade of INV on anterior rhinoscopy examination was Grade 2, in 11 patients of DNS with caudal dislocation (40.7%), four patients of DNS with spur (30.8%), and three patients of DNS with external deformity (37.5%), which was statistically significant in our study. In the majority of patients with all types of nasal septal deviations with or without external nasal deformity, INV (angle) of less than 9 degrees was noted, which was statistically significant. A linear relationship, ie., Grade 0 INV in Type I, Grade 1 INV in types II, III, IV, and V, and Grade 2 in Type VII was observed. Our study is on par with the literature questioning the dogma of the normal angle of INV being 9-15 degrees. Conclusion We were able to establish a positive and complimentary role of anterior rhinoscopic and endoscopic assessment of INV. The proposed novel classification of the angle of INV by endoscopic assessment gives a better insight into the association of INV with various nasal septal deformities with or without external nasal septal deviation.

Biomedical Waste Management and Its Importance: A Systematic Review.

The waste generated in various hospitals and healthcare facilities, including the waste of industries, can be grouped under biomedical waste (BMW). The constituents of this type of waste are various infectious and hazardous materials. This waste is then identified, segregated, and treated scientifically. There is an inevitable need for healthcare professionals to have adequate knowledge and a proper attitude towards BMW and its management. BMW generated can either be solid or liquid waste comprising infectious or potentially infectious materials, such as medical, research, or laboratory waste. There is a high possibility that inappropriate management of BMW can cause infections to healthcare workers, the patients visiting the facilities, and the surrounding environment and community. BMW can also be classified into general, pathological, radioactive, chemical, infectious, sharps, pharmaceuticals, or pressurized wastes. India has well-established rules for the proper handling and management of BMW. Biomedical Waste Management Rules, 2016 (BMWM Rules, 2016) specify that every healthcare facility shall take all necessary steps to ensure that BMW is handled without any adverse effect on human and environmental health. This document contains six schedules, including the category of BMW, the color coding and type of containers, and labels for BMW containers or bags, which should be non-washable and visible. A label for the transportation of BMW containers, the standard for treatment and disposal, and the schedule for waste treatment facilities such as incinerators and autoclaves are included in the schedule. The new rules established in India are meant to improve the segregation, transportation, disposal methods, and treatment of BMW. This proper management is intended to decrease environmental pollution because, if not managed properly, BMW can cause air, water, and land pollution. Collective teamwork with committed government support in finance and infrastructure development is a very important requirement for the effective disposal of BMW. Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve a goal of a green and clean environment. The aim of this review article is to provide systematic evidence-based information along with a comprehensive study of BMW in an organized manner.

Cartilage's Contribution in Otology: A Comprehensive Review of Its Role in Ear Surgery.

This comprehensive review thoroughly examines the pivotal role of cartilage in otologic surgery, elucidating its multifaceted contributions to both cosmetic and functional outcomes. From reconstructing the external ear to reinforcing the tympanic membrane and restoring the ossicular chain, cartilage emerges as a versatile and resilient biological material with unique properties that make it an invaluable resource for otologic surgeons. The review explores the nuances of cartilage's applications in various surgical contexts, emphasizing its significance in promoting tissue regeneration and healing. The text delves into advancements in tissue engineering, biodegradable scaffolds, and 3D printing technology, pointing toward a future where more precise and personalized interventions may redefine the landscape of otologic surgery. The convergence of these innovations holds the promise of elevating the standard of care, minimizing complications, and improving the quality of life for patients undergoing cartilage-based otologic procedures. This synthesis of current knowledge and future possibilities provides a valuable resource for otologists, surgeons, and researchers in the dynamic field of otology.

A Review of the Middle Ear Risk Index as a Prognostic Tool for Outcome in Middle Ear Surgery.

This review article aims to scrutinize the studies conducted to determine a relationship between preoperative Middle Ear Risk Index (MERI) factors and postoperative graft acceptance and audiological gain in patients undergoing tympanoplasty procedures in middle ear surgeries. Critical analysis is done on numerous research and types of studies that were done in this area during the past years. The clinical and technical aspects connected to disease and its care have a variety of effects on the morphological and functional outcome of tympanoplasty. A better comprehension of these characteristics aids in better disease prognostication, surgical planning, and patient counseling. At the end of this review, we can conclude that the MERI score is inversely proportional to the post-operative graft acceptance and audiological gain. The accumulated MERI is hence a good prognostic factor for the hearing outcome of surgery.

Association of Eating Disorders in Prenatal and Perinatal Women and Its Complications in Their Offspring.

Numerous studies revealed that women in the first trimester of pregnancy (prenatal) and 6-12 months after delivery of a newborn (postnatal) suffer from eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. Pregnancy may increase or decrease the symptoms of eating disorders. It varies from person to person. The mother faces many complications during this period which may also affect the newborn child. Weight loss is an essential symptom of eating disorders, which may cause extreme anxiety and depression during and after pregnancy. Stress is another symptom that is associated with binge eating disorders. The main aim of this narrative review article is to critically analyze and discuss the association of prenatal and postnatal factors that lead to different eating disorders in the mother and child. A total of 38 published and standard articles were selected for this review. The studies under consideration showed numerous methodological shortcomings, necessitating additional investigation to explain these discrepancies. The evidence points to a connection between prenatal and perinatal variables, and the children of these women also develop eating disorders. Earlier research focused on linking pregnancy and eating disorders, mainly emphasizing anorexia nervosa and bulimia nervosa. However, any significant correlation between binge eating disorder and pregnancy is yet to be found. In the first half of pregnancy, about 33%-35% of women who had binge eating disorder before becoming pregnant no longer met the diagnostic criteria, their illness improved, and they seemed to recover. These patients with eating disorders are more likely to have pregnancy-related complications and births. Therefore, creating a multidisciplinary screening strategy and guidelines for managing and supervising this particular patient population makes sense.

Management of Eustachian Tube Dysfunction: A Review.

The Eustachian tube is a crucial pneumatic component of the head and neck region and is often neglected as an important site of insidious pathologies. In our literature review, we negotiate the management of eustachian tube dysfunction and explore the various therapeutic and surgical options available at our disposal. We begin by investigating the physiological nature of the eustachian tube and its role in the body's functioning. We also list and elaborate on the various pathologies affecting the Eustachian tube and its associated structures. The review then outlines eustachian tube dysfunction and discusses the pathophysiology involved in the genesis of the condition and its progression. Further, the review explores the tools most commonly used to diagnose or alleviate the condition, including, but not limited to, the Valsalva maneuver, Toynbee maneuver, tympanometry, pressure chamber test, and video nasopharyngoscopy. We also touch on The ETS-7 questionnaire and then on the various surgical interventions that may be used to manipulate the condition. The review also describes conventional tympanostomy and myringotomy, along with more novel techniques such as microwave ablation, laser eustachian tuboplasty, and balloon eustachian tuboplasty. We conclude by establishing the most favorable course of treatment in cases of eustachian tube dysfunction.

Adenotonsillar Hypertrophy and Cardiopulmonary Status: A Correlative Study.

Introduction Adenotonsillar hyperplasia in childhood is a common phenomenon. It has been reported in the literature that increased upper-airway resistance resulting from hypertrophied tonsils and adenoids can cause intermittent airway obstruction, chronic alveolar hypoventilation, and even lead to severe cardiopulmonary complications such as right ventricular (RV) failure and cor-pulmonale, a near-lethal culmination of pulmonary artery hypertension (PAH). This study was undertaken to explore and examine the association of adenotonsillar hypertrophy and cardiopulmonary status in patients with complaints of upper airway obstruction below the age of 20 years and to analyze the effect of adenotonsillar enlargement on pulmonary function tests and cardiac aberration reflected in the electrocardiography (ECG) changes.  Methods This study included patients visiting or admitted to the Otolaryngology/Ear, Nose, and Throat (ENT) and Paediatrics department of Acharya Vinoba Bhave Hospital, Sawangi (Meghe), Wardha, Maharashtra, India. It is an Observational Prospective Study conducted on 75 Patients (50 cases and 25 controls) below the age of 20 years. Inclusion criteria for cases included all patients of adenoid hypertrophy (AH) and adenotonsillar hypertrophy (ATH). Inclusion criteria for controls comprised all patients with a history and clinical examination not suggestive of any upper airway and pulmonary disease. All the patients were subjected to pulmonary function tests (PFT) and electrocardiography (ECG), and the values were compared. Results It was found that there was a decrease in the value of the parameters of the pulmonary function tests (PFT), which includes forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (FEV1/FVC) and peak expiratory flow rate (PEFR) with increasing severity of the endoscopic grades of adenoid hypertrophy. This was found to be statistically significant. All the PFT parameters were significantly lower in the subset of patients with ATH compared to those with AH only, emphasizing the compounding effect of tonsillar volume. Between case and control subjects also, these differences were statistically significant. Seventeen (34%) out of the 50 patients studied in the present work were found to have abnormalities in their ECG, while no subject in the control group had any departure from normal. Nine of these 17 patients had AH, and eight had the adenotonsillar disease. In the 9 patients (18%) with AH, sinus arrhythmia was seen in 5 (10%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. In 8 patients (16%) with AH, sinus arrhythmia was seen in 4 (8%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. Overall, sinus arrhythmia was the commonest finding seen in 9 patients (18%). Conclusion Chronic obstructive adenotonsillar hypertrophy causes significant cardiovascular and pulmonary changes, which is often overlooked in the clinical setting. Symptoms of progressive pulmonary hypertension are minimal until the rapid onset of severe cardiac decompensation occurs. These entire cascades of events are reversible in the early stages and thus mandate early detection and treatment. Performing PFT and ECG in children with adenotonsillar disease is not mandatory but profitable even in the absence of obvious symptoms of upper airway obstruction.

Otogenic Brain Abscess: Judicious Management in a Case of Chronic Suppurative Otitis Media.

Intracranial consequences from chronic otitis media can be dreadful. Meningitis is the most frequent complication followed by a cerebral abscess. In this pre-antibiotic era, otogenic brain abscess is rare, but it poses one of the life-threatening complications of otitis media. In recent years, brain abscess was noticed almost only in patients of chronic Otitis media with cholesteatoma. A case of a 36-year-old non-diabetic male patient with an otogenic cerebellar abscess, who presented with no cerebellar signs and unique intraoperative ossicular chain status was successfully managed by a combined approach of otolaryngology and neurosurgery, is presented in this report.