Dysphonia in Children; Clinical Profile, Conservative Treatment Modalities and Outcomes: An Institutional Experience.

Dysphonia in children represents broad-spectrum voice problems. Global prevalence of hoarseness in school-aged children is 6-23%. It impairs communication of child, thus affects social life. This study shows importance of appropriate preventive measures for paediatric dysphonia and diagnosis of voice problems in early stages. Continuous voice abuse in children can cause recurrent voice disorders as well as speech problems. This prospective study included 104 patients(78 males and 26 females) of 6-15 years, with voice problems, in a tertiary care centre, North Kerala, during June 2022-March 2023. Chief complaints and risk factors evaluated. Voice analysis using maximum phonation time (MPT), Child Voice Handicap Index for Parents (CVHI-10-P), Reflux Symptom Index (RSI) and clinical examination including indirect laryngoscopy (IDL) and 70degree scopy were done. Treatment given for a maximum of 2 weeks. Advised voice rest and voice therapy throughout. All patients followed up after 2 weeks and up to 3 months. Voice abuse was the commonest risk factor and voice change, the commonest symptom. MPT reduced in 23% males and 14% females. According to CVHI-10-P, screaming was present in 52% children and symptoms present mostly in afternoon. RSI identified the role of LPRD in dysphonia. IDL and 70 scopy identified most common diagnosis as vocal nodule. Treatment given and follow-up period noted. All except vocal polyp had complete relief. Most common diagnosis was vocal nodule which resulted from chronic voice abuse. Appropriate preventive measures, early diagnosis and adequate treatment of voice problems should be considered. Conservative management in early stages is recommended.

A study of closure of tympanic membrane perforations by chemical cauterisation.

To study the effectiveness of chemical cautery with patching on chronic tympanic membrane perforations of the pars tensa. Thirty-eight patients with dry tympanic membrane perforations due to inflammatory or traumatic etiology were selected after treating the primary etiological factors like septal deviation and allergic rhinitis. Fifty percentage silver nitrate was used to cauterize the margin and the perforation was covered with thin sterile aluminium foil as a patch. A maximum number of five applications were made, and the patients were followed up for the next 5 years. In this series of 38 patients, highest success was noted among those patients with traumatic perforation, while larger perforations were reduced to small pinhole sizes which were successfully closed by myringoplasty. An overall success rate of 73.75% was achieved. This is a time tested useful method which was popularized by Derlacki (1953), to close small to moderate sized tympanic membrane perforation and should be considered as a first line management in the treatment of tympanic membrane perforation prior to any surgical intervention. Apart from being a simple and economical mode of treatment, it is associated with minimal complications. Though various materials have been used to modify this technique, the principle remains the same and the results obtained in this study is comparable with the previous ones.

Removal of malachite green from aqueous solution by activated carbon prepared from the epicarp of Ricinus communis by adsorption.

The use of low-cost, locally available, highly efficient and eco-friendly adsorbents has been investigated as an ideal alternative to the current expensive methods of removing dyes from wastewater. This study investigates the potential use of activated carbon prepared from the epicarp of Ricinus communis for the removal of malachite green (MG) dye from simulated wastewater. The effects of different system variables, adsorbent dosage, initial dye concentration, pH and contact time were investigated and optimal experimental conditions were ascertained. The results showed that as the amount of the adsorbent increased, the percentage of dye removal increased accordingly. Optimum pH value for dye adsorption was 7.0. Maximum dye was sequestered within 50 min of the start of every experiment. The adsorption of malachite green followed the pseudo-second-order rate equation and fits the Langmuir, Freundlich, Dubinin-Radushkevich (D-R) and Tempkin equations well. The maximum removal of MG was obtained at pH 7 as 99.04% for adsorbent dose of 1 g 50 mL(-1) and 25 mg L(-1) initial dye concentration at room temperature. Activated carbon developed from R. communis can be an attractive option for dye removal from diluted industrial effluents since test reaction made on simulated dyeing wastewater showed better removal percentage of MG.

Frontoethmoidal mucocele with orbital and intracranial extension.

We report a case of a giant frontoethmoidal mucocele extending to the orbit and anterior cranial fossa. Clinically, the patient had an insidious onset of clinical presentation with no intracranial symptoms. We present its CT, MRI and histpathological features with a brief review of literature. Various surgical approaches are also discussed.

A case of solitary fibrous tumour of the nose and paranasal sinuses.

Solitary fibrous tumours (SFT), formerly known as benign fibrous mesothelioma, are rare mesenchymal spindle cell neoplasms, originally described in the pleura, but now found to arise in many other locations such as mediastinum, urogenital tract, face, nose, paranasal sinuses, orbit, meninges, ear, buccal mucosa, tongue, salivary gland etc. It was first described as a distinct neoplasm in 1931 by Klemperer and Rabin. On reviewing the literature, so far, 21 cases have been reported involving the nose and paranasal sinuses. A case of solitary fibrous tumour of the nose and paranasal sinuses is presented.

An unusual case of congenital choleasteatoma in the mastoid with epidural abscess and cutaneous fistula.

A unique case of congenital choleasteatoma within the mastoid region of the temporal bone is described. The patient presented with a cutane ous fistula into the external auditory canal and epidural abscess. The clinical, radiological, histopathological and operative findings are discussed. A review of the literature shows only one report of a similar case.