Foodomics-based metabolites profiling of the Greek yogurt incorporated with unripened papaya peel powder.

The food waste of the fruit processing industry is rich in many bio-active components such as polysaccharides, polyphenols, peptides, etc. that own multifaceted health benefits. The valorization of this waste is an intriguing optimization method for various dairy products. Meanwhile, LC-MS-based foodomics has been an emerging approach for the quantitative and qualitative analysis of dairy foods. Untargeted metabolomics has been done of the optimized functional yogurt that contains different levels of unripened papaya peel powder (UPPP) using high-resolution mass spectroscopy for analysis of added bio-active components in the matrix. UPPP comprises a high content of phytochemicals which could give functionality and therapeutic effect to the Greek yogurt. A total of 36 functional metabolites have been identified which have various health-beneficial attributes. Kaempferol, ostruthin, putative carpaine derivatives, etc. are some of the metabolites of high importance with a wide area coverage in the metabolome. This work highlights the bioactivity of the UPPP and its prebiotic properties added to the functional yogurt as an independent ingredient. The incorporated plant-based ingredients like UPPP can effectively enhance the functional attributes of Greek yogurt, which is a potential synbiotic food.

Translabyrinthine Excision of a Transmodiolar Intralabyrinthine Schwannoma Mimicking Meniere's Disease: A Case Report.

Intralabyrinthine schwannomas (ILSs) are rare tumors involving the otic capsule. Notably, they are often misdiagnosed because their symptoms mimic those of other, more common inner ear pathologies. Diagnosis requires high-resolution contrast-enhanced magnetic resonance imaging (MRI), which reveals filling defects (using a T2-weighted MRI sequence) or focal enhancement (using a T1-weighted MRI sequence with gadolinium enhancement) in the inner ear. A 52-year-old male patient with intractable vertigo or single-sided deafness should raise suspicion of this clinical entity as a differential diagnosis. Translabyrinthine excision of the tumor along with auditory rehabilitation using a cochlear implant can provide good outcomes with minimal morbidity in carefully selected cases. Here, we present an interesting case of a transmodiolar ILS mimicking Meniere's disease, wherein surgery using the translabyrinthine approach and an extended cochleostomy yielded favorable outcomes.

'Lateral Aberrant Thyroid Carcinoma' or 'Thyroglossal Duct Cyst Carcinoma Metastasizing to Neck Node': Can we Decide in this Interesting Case Report?

Lateral aberrant thyroid(LAT) belongs to subset of ectopic thyroid, mostly presenting as asymptomatic lateral neck swelling and are challenging to diagnose without histopathological examination. Malignant transformation in LAT is even rare and is best managed by surgical excision. Here, we report a case of papillary carcinoma of LAT, but with an unusual post-operative finding, revealing papillary carcinoma of thyroglossal duct cyst.

Post Surgical Outcomes in Paediatric Adenotonsillar Hypertrophy with Obstructive Sleep Apnea: Subjective and Objective Evaluation.

The aim of the study was to determine the post surgical outcomes in pediatric adenotonsillar hypertrophy with OSA using portable polysomnography (PSG), OSA 18 Questionnaire and Quality of life (QoL) scores. Secondly to correlate the subjective outcomes with objective scores of polysomonography. A prospective, single-arm, nonrandomized, single center study was performed at a tertiary care centre on children aged 3-12 years (n = 30) with adenoid hypertrophy/ tonsillar hypertrophy/adenotonsillar hypertrophy and symptoms suggestive of OSA. All subjects underwent appropriate surgical intervention. A portable PSG and OSA 18 questionnaire evaluation was performed pre surgery and 06 weeks post surgery to assess objective and clinical assessment for OSA. The mean age of children enrolled in the study was 8.68 ± 3 years. The mean pre treatment AHI was 12.56 ± 13.16 which improved to 1.72 ± 1.53 post surgery and was statistically significant (p < 0.05, Wilcoxon signed rank test). There was a statistically significant improvement in other PSG indices such as RDI and ODI post surgery also. The mean total symptom score (TSS) and QoL score also showed a statistically significant improvement post treatment (p < 0.05). However there was no correlation between the PSG and OSA 18 questionnaire scores pre and post surgery. Children with OSA like symptoms can undergo a portable polysomnography pre and post surgery to demonstrate severity of OSA and objectively monitor improvement in OSA post treatment. In the absence of availability of PSG, OSA 18 questionnaire is a suitable alternative to monitor disease severity and outcomes. Further studies may plan to include impact of paediatric OSA on other function such as the cardiac, dentition & malocclusion and neurocognitive function.

An Unusual Finding During Exploratory Tympanotomy in a Case of Conductive Hearing Loss Mimicking Clinical Otosclerosis: A Case Series.

Conductive hearing loss with normal otoscopic findings has many differential diagnosis, but the diagnosis of otosclerosis is retrospective after exploratory tympanotomy. Congenital ossicular anomalies in isolation are rare and often have a delayed diagnosis, particularly if unilateral. Herein we present a rare case of stapes abnormality that was encountered as a surprise during exploratory tympanotomy in a case of conductive hearing loss mimicking clinical otosclerosis and was managed accordingly.

Evaluation of swallowing in patients with T3/T4 oral squamous cell carcinoma.

Background: Follow-up of patients treated for head and neck cancer is an important part of the overall treatment. Oral cancers are one of the leading causes of dysphagia. Swallowing dysfunction occurs owing to the disease itself, its predisposing factors, and the treatment. This study aims to evaluate swallowing dysfunction in patients with oral cavity cancers. Methods: This prospective study was carried out in a tertiary care hospital institution. Thirty patients with T3, T4 oral cancers were evaluated using institutional dysphagia score and fiber optic endoscopic evaluation of swallowing (FEES) (Penetration-Aspiration Scale, Yale Pharyngeal Residue Scale) before treatment, after surgery, and after adjuvant therapy. Results: Advanced-stage tumor, larger resections, and adjuvant therapy are risk factors for dysphagia postoperatively. Although the dysphagia score is our institutional score, the results are promising, that is, 10 % of patients having symptoms at baseline evaluation, which increased to 60% and 70% after surgery and adjuvant radiotherapy respectively. Our study findings of the Penetration Aspiration Scale are 13% aspiration rate at the baseline evaluation, which increased to 57% and 73% after surgery and after adjuvant radiotherapy, respectively, and these results are consistent with those of other report studies. The Vallecular Residual Scale showed that there was a significant association between three different timelines and demonstrated dysphagia among study subjects. Conclusion: Subjective and objective assessment of swallowing dysfunction before and after the treatment of head and neck cancers is underreported and underrecognized. Most of the patients in our study had significant swallowing impairment after treatment. FEES is a very effective procedure to diagnose dysphagia and will help in incorporating better preventative and rehabilitative measures.

Utilization of PET/CT Scan in Head and Neck Carcinoma: A Tertiary Care Hospital Experience.

Objective: PET/CT scan has been increasingly used in assessment of Head and Neck cancer prior to treatment for evaluation and for surveillance. In this study we aim to assess the utilization of PET/CT scan at a tertiary care hospital. Methods: Retrospectively data was reviewed of all patients of Head and Neck cancer who underwent PET/CT scan for workup or for follow-up between July 2018 and December 2019. PET/CT scan done in the pre-treatment assessment and post-treatment surveillance were analyzed for its utility. Results: A total of 145 patients were included. The main indication for pre-treatment PET/CT scan was loco-regionally advanced disease (62 of 90 patients, 68.8%). No specific indication was noted in 19 patients (21%). A significant change in treatment decision was seen in pre-treatment patients based on M stage following a PET/CT scan. However, no change was noted on the basis of T or N stage. In the post-treatment surveillance there was a significant correlation of type of recurrence with clinical assessment and indication for PET/CT scan. 37 out of 87 patients (42.5%) underwent PET/CT scan for no specific reason, of which, 07 patients (18.9%) were detected to have distant metastasis. Conclusion: Role of PET/CT in the pre-treatment assessment is very limited and maybe confined to advanced local or regional disease. Post-treatment surveillance with PET/CT scan has a promising role and must be done as a baseline during 1st follow up at 03 months in all patients who have advanced disease and have undergone multi-modality treatment for the same.

Approach to Management of Cerebrospinal Fluid Rhinorrhea: Institutional Based Protocol.

The role of otolaryngologist in the management of CSF rhinorrhea is expanding. It is prudent to evaluate all cases of CSF leak, understand the etiological causes and formalize a working approach to management of such cases to yield better outcome. A retrospective descriptive study of 39 cases of proven CSF rhinorrhea treated at a tertiary care center between January 2014 to August 2019. The data retrieved were analyzed for age, gender, weight, etiology, recurrence of the disease, history of meningitis, nasal or neurosurgical intervention in past, imaging inform of CT and MR cisternography as and when required. This was aimed at understanding the various etiological types of CSF rhinorrhea and work out a management approach. The patients with skullbase tumors who presented with CSF Rhinorrhea were excluded from the study sample. There were 18 cases of spontaneous CSF rhinorrhea and 20 cases of traumatic CSF rhinorrhea. The mean BMI of spontaneous gp was 32.9 ± 2.46 kg/m2 while in traumatic group was 25.7 ± 2.94 kg/m2 and difference was statistically significant. None of the spontaneous CSF rhinorrhea cases showed features of raised ICP preoperatively either clinically or on imaging except empty sella in 14 of 18 cases. 6 of 18 cases of spontaneous category while 01 of 20 cases in traumatic had recurrence and the recurrence rate was significantly (p < 0.05) higher in spontaneous group. In traumatic group 7 were iatrogenic, 8 were occult traumatic and rest were acute traumatic. 4 of traumatic and 1 spontaneous group had history of meningitis and the incidence was 12.8% in our study group. Early identification and localization of CSF fistula is necessary to reduce morbidity and mortality associated with it. Risk of meningitis is high in CSF rhinorrhea especially in traumatic group. The etiology of CSF rhinorrhea has a bearing on the management and spontaneous CSF rhinorrhea has higher rate of recurrence.

Role of subjective visual vertical in patients with posterior canal benign paroxysmal positional vertigo as a prognostic marker after canalith repositioning maneuver.

Objective: To study the potential role of subjective visual vertical (SVV) as a prognostic marker for canalith repositioning maneuver (CRM) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) for the Indian population. Methods: SVV was examined in 30 patients with PC-BPPV before and after canalith repositioning maneuver and after complete resolution of PC-BPPV. Study parameters included the mean of 10 angular tilt readings and direction of deviation, which were compared before and after CRM and following complete resolution of PC-BPPV. Results: The angle of SVV tilt was greater and deviated towards the affected ear before CRM in all patients, which decreased significantly shortly after CRM and continued to decrease after complete resolution of PC-BPPV (p < 0.0001). Conclusions: SVV can be used to test utricular dysfunction in PC-BPPV. The angle of tilt improves in response to CRM, which may be used as a prognostic marker in patients with PC-BPPV receiving CRM.

Beyond Vertigo- Perceptual Postural Phobic Dizziness (PPPD): Our experience.

Notwithstanding current understanding of vertigo, there are various clinical scenarios which are intriguing for clinicians, where patients have been too symptomatic but the presentation does not fit into any diagnosis. We stumbled upon a new entity during literature search known as Persistent Postural Perceptual Dizziness (PPPD). It fills the lacuna where we are often left wanting for diagnosis in the existing pool of knowledge. This case series has been prepared keeping in view the lack of data regarding PPPD in Indian population. For better understanding we present the illustration of our patients in this case series. We presented the details of three patients who were diagnosed as PPPD and managed effectively and followed up for one year. The nomenclature portrays the core concept of dizziness. The diagnostic criteria clearly define PPPD. It should not be used as escape or exclusion diagnosis. Our case series highlights various presentation of, not so uncommon, PPPD in Indian population. The case series has been brought out to address the deficiency of knowledge in dealing with intriguing vertigo. Careful thorough history is important to reach a diagnosis and avoids unwarranted vestibular sedatives. It highlights that proper counselling and vestibular rehabilitation can help the patients overcome their chronic disability.

Use of three-dimensional printing for the osteoplastic flap approach: A viable technique.

The osteoplastic flap technique is the open and direct approach to the frontal sinus and is especially useful when disease extends laterally into the frontal sinus. One of the vital steps of surgery is delineation of the boundary of the frontal sinus. This can usually be performed either by using the classical 6-ft Caldwell view X-ray template or more recently by application of the image-guided navigation system. The present article describes an alternative technique of using 3D printing technology for preoperative creation of the onlay template to mark the limits of the frontal sinus during osteoplastic flap technique and its advantages.

Primary Secretory Paraganglioma of Facial Nerve Canal: A Case Report.

Paragangliomas (PGLs) of Head and Neck region account for 0.6% of Head and Neck Tumours. These may originate in paraganglionic tissues in the area of carotid bifurcation, vagus nerve, tympanic plexus and very rarely along vertical Facial nerve canal (FNC). We intend to describe a rare case of primary paraganglioma of FNC associated with hypoxia of submarine environment, its characterization and multidisciplinary approach towards its management.

Audiological and Surgical Outcomes of Pediatric Cochlear Implantation in Mondini's Dysplasia: Our Experience.

OBJECTIVES: Aim of present study is to compare audiological and surgical outcomes in prelingual deaf children with Mondini's dysplasia (MD) and those with normal inner ear anatomy. MATERIALS AND METHODS: Retrospective data was collected from Jan 2008 to Dec 2016. Children with bony IEM other than MD, syndromic association, multiple disabilities, those lost to follow up, and perilingual or postlingual deafness were excluded from study. Audiological outcomes for auditory perception (CAP score) and speech intelligibility (SIR score) was noted for a follow up period of 1 year. RESULTS: Mean age at implantation was 2.8 years (Range of 2 to 6 years). 2 patients had intraoperative CSF ooze which was controlled intraoperatively by conservative measures. Post operative facial nerve function was normal in all patients. None of the patient in either group had any complications at one year of follow up period. There was statistically significant improvement in CAP - SIR score in Group A at 6 - 12 months compared to pretreatment. There was no statistically significant difference between the 2 groups in terms of CAP - SIR score at 6 - 12 months. CONCLUSION: The study stresses the fact that cochlear implantation can be safely performed in children with MD although there is a risk of intraoperative CSF leak which can be controlled intraoperatively. Cochlear implantation in children with MD has good surgical, auditory and speech outcomes at par with children with normal bony inner ear anatomy.

A Study of Outcome of Pediatric Cochlear Implantation in Patients with Cochleovestibular Nerve Deficiency.

OBJECTIVES: A cochleovestibular nerve deficiency (CVND) could compromise stimulation of nerve by electrical pulses delivered from a cochlear implant, thereby hindering activity along auditory pathway. The evaluation of children with congenital hearing loss with a high-resolution magnetic resonance imaging is presently the investigative modality of choice to diagnose CVND. The aim of this study was to determine the outcomes in pediatric cochlear implant recipients with a diagnosis of CVND. The objectives included (1) to study the prevalence of CVND among children with prelingual congenital severe to profound hearing loss; (2) to assess post cochlear implantation (CI) outcomes in children with CVND using categories of auditory performance (CAP), speech intelligibility rating (SIR), and cortical auditory evoked potentials (CAEPs); and (3) to propose a management protocol for these children. MATERIALS AND METHODS: All CI procedures performed during the study period in children 5 years or younger were included in study. All patients who were older than 5 years or had syndromic associations, multiple disabilities, second side or revision CI were excluded from the study. Children with unilateral cochleovestibular nerve aplasia and all other cases of CVND (type IIa and IIb) were advised to undergo CI on side with more radiologically robust nerve and/or cochlea anatomy. Children with bilateral CVND were included in group A, and age-matched cochlear implant candidates with normal cochleovestibular nerve anatomy were included in group B for statistical comparison of outcomes. RESULTS: In group A, post CI CAP and SIR, CAEP amplitude and latency at 12 months showed statistically significant difference (p<0.05) compared with preoperative values. However, mean score of CAEP latency and amplitude and SIR score was worse for group A compared with group B at 12 months, which was statistically significant (p<0.05). CONCLUSION: This study supports the fact that CI is a viable option to be offered in children with CVND (type IIa and IIb) for the development of auditory perception and speech.

Transnasal Transsphenoidal Approach for Pituitary Tumors: An ENT Perspective.

Endoscopic transnasal transsphenoidal (ETNTS) approach was first described in 1992 and is standard approach for the resection of benign pituitary adenomas. This prospective study aims in incidence and preoperative assessment of extent of the pituitary adenoma, peroperative findings of transnasal transsphenoidal excision, techniques of skull base repair, complications and its management in a tertiary centre. A prospective analysis from Jan 2017 to May 2019, of patients undergoing ETNTS approach of pituitary adenomas was made in terms of incidence in various age-groups, type of adenoma, operative findings including CSF leak, repair of the skull base defect, complications encountered and its management was done in a tertiary care centre and compared with the present literature. A total of 141 patients underwent ETNTS, with highest number of cases found in 41-50 years age-group with mean age of 42.6 years. Male: Female ratio was 1.6. Macroadenoma was in 123 patients while 18 had microadenoma, of these 63.74% were functional adenoma, highest of GH secreting, while 36.26% were non-functional. Mean surgical time was 98.4 min ± 21.2 min. Peroperative CSF leak was in 30.5% cases in various grades. Closure techniques included use of fat, multilayer techniques, Hadad's flap and gasket technique as per the type of CSF leak. Neurological and rhinological complications were 6.38% each. This study is focused on the ENT perspective of the endoscopic transnasal trans-sphenoidal approach for pituitary adenomas. The reduced rate of morbidity and complications is encouraging. The endoscopic skull base defect closure is challenging and requires skill, meticulous approach and synchronised team work in order to achieve a favourable outcome. The incidence of CSF leak can be minimised and if encountered has to be dealt in an organised manner, thus contributing to a reduced rate of complications. The complications encountered must be foreseen and managed with a proficient approach.

Voice Quality in Cochlear Implant Recipients: An Observational Cross Sectional Study.

Children with hearing loss are more likely to suffer from voice and speech disorders than with normal hearing due to their poor and less robust auditory feedback mechanisms. Prelingually deaf children are not able to supervise their own voice due to lack of auditory feedback. Cochlear implanted children achieve better hearing and consequently enhanced speech intelligibility. Various parameters of voice improve with continous usage of cochlear implant. However all the vocal parameters do not show similar degree of change. Previous studies have assessed the voice quality of cochlear implantees and have given inconsistent results. The aim of the study is to compare the voice quality of cochlear implant children with normal subjects using objective and subjective methods. The study was undertaken after obtaining clearance from the Institutional Ethics committee. Written informed consent for carrying out voice analysis was taken from the parents. The voice analysis of 42 normal and 42 cochlear implant children were done using the Dr Voice software by Tiger Inc. All the children were age and sex matched. The parameters assessed were fundamental frequency, maximum phonation time, jitter%, shimmer% and harmonics to noise ratio. The findings of both the group were compared. The cochlear implanted children showed significant deviation of all the measured parameters as compared to the normal children. The voice quality of the implanted children is poor and deviant from the normal. Even after continuous usage of cochlear implant for 1 year the voice quality of these children did not reach to the levels of their normal hearing peers.

A Retrospective Study of Cochlear Re-Implantations - Experience from a Large Centre in India.

OBJECTIVE: Cochlear re-implantation (CRI) is becoming increasingly common throughout the world. However, studies regarding CRI incidence and etiology are lacking from developing countries like ours. The aim of this study was to present the Indian experience with CRI based on our experience. Objectives were to determine the incidence and the indications of CRI and the cumulative survival rate (CSR) of cochlear implantation (CI). METHODS: Our study was a retrospective one, conducted at a tertiary care centre in southern India. 1,500 consecutive cochlear implanted ears from 1997 to 2016 were studied. All patients who underwent CRI during this period were included in the study. RESULTS: There were a total of 53 ears (31 male and 22 female ears) who underwent CRI. This gives an incidence of 3.53%. The most common indication of CRI was device failure in 39 ears contributing to 73.6% of the total CRI. The overall CSR of CI in pediatric population was 96.5% over a 20-year period. CONCLUSION: The CRI incidence and etiology at our centre appears to reflect the findings of the literature. Cochlear implant centres across the world should report the CSR of devices used at their respective centres so that it can be made an important criterion in choice of implant.

Outcomes of Cochlear Implantation in Auditory Neuropathy Spectrum Disorder and the Role of Cortical Auditory Evoked Potentials in Benefit Evaluation.

OBJECTIVE: To compare the outcomes of cochlear implantation (CI) in children with auditory neuropathy spectrum disorder (ANSD) and age-matched controls with profound sensorineural hearing loss, using categories of auditory performance (CAP), speech intelligibility rate (SIR), meaningful auditory integration scale (MAIS), and meaningful use of speech scale (MUSS), and to determine the role of Cortical Auditory Evoked Potentials (CAEP) in benefit evaluation after CI. METHODS: Ten patients (8 males and two females) with ANSD who underwent CI were included in the study. Auditory and speech scores were compared between baseline and after 12 months of habilitation in children with ANSD. Post CI speech scores in children with ANSD were compared with the control group (age-matched children with profound sensorineural hearing loss) at 12 months of habilitation. P1 latency of CAEP has a good correlation with auditory and speech scores in children with ANSD in the study group. RESULTS: Significant benefits were seen in children with ANSD who underwent CI compared to the baseline CAP and SIR scores and one year after habilitation. There is no statistically significant difference in outcomes between the two groups with CI (ANSD and profound sensorineural hearing loss) (p-value: CAP=1.00, SIR=0.84, MAIS=0.33, MUSS=0.08). Speech perception in noise test (SPIN) scores in children with ANSD were 63% and 80% with 0 dB signal noise ratio (SNR) and +10dB SNR, respectively. P1 wave of CAEP has a good correlation with the subjective outcomes. CONCLUSION: CI in children with ANSD has showed benefits comparable to children with profound sensorineural hearing loss. CAEP is a useful tool in objectively assessing cortical maturity in children with ANSD following CI.

Audit of Bilateral Simultaneous Cochlear Implantation in Pediatric Population: South Indian Study.

OBJECTIVE: To conduct a medical audit of bilateral simultaneous cochlear implantation (CI) in patients with severe prelingual sensorineural hearing loss (SNHL). METHODS: A medical audit of a tertiary care ear, nose, and throat center in Southern India was conducted on data collected from January 2007 to December 2014. All cochlear implantees <6 years of age with severe bilateral SNHL who underwent bilateral simultaneous CI were included in the present study. The exclusion criteria were children >6 years, sequential bilateral CI, revision cases, abnormal or malformed cochlea, and children with global developmental delay in milestones. Subjective outcome scores used were Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). RESULTS: The CAP and SIR results showed that 20% of implantees achieved peak scores of 7 and 5, respectively. Mean CAP and SIR scores at 12 months were 5.4 and 3.1, respectively. CONCLUSION: The present study supports the claim that bilateral CI in severe prelingual bilateral SNHL is better than unilateral and recommends that bilateral CI should be the standard of care in children.

Translabyrinthine approach to internal auditory meatus: A retrospective study.

BACKGROUND: Ear and the lateral skull base surgery is challenging and yet fascinating for a Neuro-otologist. A thorough knowledge of the complex anatomy is indispensable for the surgeon in order to provide the best possible care. METHODS: The aim of the study was to highlight the present day indications for translabyrinthine approach to IAM from a Neuro-otologist perspective. RESULTS: There were a total of 7 patients who underwent Translabyrinthine approach at our centre. In the present study we have reported cases of Vestibular Schwannoma, Facial nerve schwannoma, Cholesteatoma involving the IAM, Meniere's disease with refractory vertigo which were managed via translabyrinthine approach. We also encountered, probably the first reported case, tuberculoma of the IAM which was clinical suspected to be vestibular schwannoma. CONCLUSION: The article presents different clinical situations where this approach can be suitably utilized and has been dealt with via a retrospective study encountered at our centre.