Interprofessional collaboration in Paediatric Obstructive Sleep Apnoea (POSA) treatment: Assessment of professional orientation levels amongst otolaryngologists in South India.

Objective: The primary goal was to assess the knowledge, attitude and practice among otorhinolaryngologists regarding orthodontic intervention for Paediatric Obstructive Sleep Apnoea (POSA). Methods: An online survey was conducted by sending an email invitation to members of The Association of Otorhinolaryngologists of Karnataka, India. A total of 141 otorhinolaryngologists participated in the survey. Results: Most of the participants (70.2%) agreed that orthodontic interventions help in opening up the airway, but very few knew about its application in nasal obstruction management. Conclusion: Otorhinolaryngologists are aware of dental effects of POSA and they believe that an interprofessional team is essential for its management. This learning can also be used to initiate interprofessional collaborations and academic and curricular improvisations for enhanced health outcomes.

Effectiveness and Safety of Prochlorperazine in Indian Patients with Acute Vertigo: Results from a Large, Prospective, Post-marketing Observational Study.

Aim: To assess the efficacy and safety of prochlorperazine in Indian patients with acute vertigo. Methods: In this prospective, multicenter, open-label, post-marketing observational study, patients with acute peripheral vertigo of different etiologies received 5 mg prochlorperazine thrice a day for 5 days. The primary endpoints were percentage of patients with improvement in (1) vertigo symptoms and (2) clinical response as per scale for vestibular vertigo severity level and clinical response evaluation (SVVSLCRE) from baseline to end of treatment (Day 6). The key secondary endpoints were (1) improvement in nystagmus grading, and (2) safety and tolerability Efficacy of prochlorperazine by route of administration of first prochlorperazine dose (oral or intramuscular) was also assessed. Results: Of 1716 enrolled patients (mean [standard deviation, SD]) age (42.0 [12.95] years; 53.6% men), 57.4% were diagnosed with Meniere's disease, followed by vestibular neuritis (17.4%), labyrinthitis (16.7%), or ear surgery (8.5%). In the overall population, 91.1% of patients showed improvement in clinical response per SVVSLCRE grading at Day 6 (p < 0.0001 vs. non-responders). Nystagmus grading was improved in 99.7% (of patients. No adverse drug reactions events were reported. Tolerability of prochlorperazine was rated as good, very good, and excellent by 43.6%, 32.9% and 20.7% of patients, respectively. Among patients with postoperative vertigo, 80.1% showed improvement in clinical response. In the intramuscular and oral subsets, 85.5% and 92.1% of patients showed improved clinical response, respectively. Conclusion: Prochlorperazine showed improvement in severity of symptoms and clinical response in all subsets of vertigo patients, with a good safety and tolerability profile. Trial Registration Number: CTRI/2022/01/039287. Date of Registration: 10 January 2022.

Rare Presentation of Venous Malformation in Parapharyngeal Space.

Introduction: Venous malformations are commonly seen in muscles like masseter, temporalis, tongue musculature, oral and airway mucosa in the head and neck region but is rarely seen in parapharyngeal space. Case Summary: We report a case of a 60 year female patient who presented with foreign body sensation of throat, sticky sensation and dysphagia to solids for 2 years. She was subjected to relevant investigations including MRI and USG guided FNAC. Following which she underwent endoscopic parapharyngeal space tumour excision and specimen was sent for HPE. Post operatively patient is doing well and symptomatically better. She is being followed up on regular basis. Conclusion: Parapharyngeal space tumours accounts for only 0.5% of head and neck tumours, of which 70 to 80% are benign and the rest are malignant. Out of the benign tumours of parapharyngeal space we should also keep in mind rare tumours like venous malformations.

Novel Rhinological Application of Polylactic Acid-An In Vitro Study.

A novel approach to the treatment of sinusitis is the use of nasal stents. The stent is loaded with a corticosteroid, which prevents complications in the wound-healing process. The design is such that it will prevent the sinus from closing again. The stent is 3D printed using a fused deposition modeling printer, which enhances the customization. The polymer utilized for the purpose of 3D printing is polylactic acid (PLA). The compatibility between the drugs and polymers is confirmed by FT-IR and DSC. The drug is loaded onto the polymer by soaking the stent in the drug's solvent, known as the solvent casting method. Using this method, approximately 68% of drug loading is found to be achieved onto the PLA filaments, and a total of 72.8% of drug loading is obtained in terms of the 3D-printed stent. Drug loading is confirmed by the morphological characteristics of the stent by SEM, where the loaded drug is clearly visible as white specks on the surface of the stent. Drug release characterization is conducted by dissolution studies, which also confirm drug loading. The dissolution studies show that the release of drugs from the stent is constant and not erratic. Biodegradation studies were conducted after increasing the rate of degradation of PLA by soaking it in PBS for a predetermined duration of time. The mechanical properties of the stent, such as stress factor and maximum displacement, are discussed. The stent has a hairpin-like mechanism for opening inside the nasal cavity.

Assessment of Otoacoustic Emissions (OAE) in Birth Asphyxiated Neonates.

One of the congenital abnormalities encountered in newborns is hearing loss. Birth hypoxia, asphyxia, and ischemia have all been implicated as primary causes of early hearing loss or deafness. Prospective study was done on neonates in NICU having APGAR scoring of < 7 in 5th minute or neonates diagnosed with birth asphyxia. OAEs were measured from both ears from 3rd to 5th day in sound-proof chamber. MRI reports of these neonates were collected and analyzed. The neonates who did not clear the 1st OAE testing further underwent a second OAE testing between 10 and 14th days. Results were further plotted. 21.9% of neonates had hearing loss. 28.1% of mothers had infections amongst which 6.3% were of hypothyroidism. 56% of neonates with normal OAE result had normal MRI findings. 71.4% of neonates showing a 'REFER' in OAE had normal MRI reports. 44% of neonates with normal OAE result had abnormal MRI report. 7 neonates who failed 1st OAE underwent secondary OAE testing after 10-14 days. 28.6% of the neonates with abnormal OAE report had abnormal MRI findings. There is no statistical correlation between OAE findings with MRI findings of the birth asphyxiated neonates. (p value = 0.671). Hence, there exists no correlation between hearing loss and birth asphyxia.

Ingrained Insight into Nasal Polyposis; Role of Human Papillomavirus: An Indian Study.

Nasal polyposis (NP) are benign lesion of nasal cavity, affecting up to 1-4% of population. It is known to have up to 70% recurrence rate. The underlying pathophysiology is still undetermined. Recent literatures have thrown light on the viral aetiology for NP. To our knowledge this is the first Indian study done, that aims to evaluate the prevalence of Human papillomavirus (HPV) in NP. It was a prospective case control study done among 40 individuals with NP and 40 healthy controls in a tertiary care centre. All the patients were subjected to routine clinical evaluation, investigations prior to proposed surgeries. The mucosal samples after the surgery were subjected to HPV DNA analysis by RT-PCR. Among the cases, the male to female ratio was 1.3:1. The mean age of patients with NP was 39 ± 14.6. The mean serum IgE levels among the case were 154 IU/ml and was significantly higher as compared to controls. Other inflammatory markers such as absolute eosinophil count, erythrocyte sedimentation rate, and neutrophil to leukocyte ration were found to be not significant. There was no HPV DNA detected among both case as well as controls. There seems to be strong association of IgE and NP, suggesting an IgE mediated pathway for its Causation. There is no association of HPV in NP.

Assessment of Quality of Life and Symptoms in Non Syndromic Paediatric Obstructive Sleep Apnoea Patients: Before and After Adenotonsillectomy.

This study aims to assess the improvement in quality of life and symptoms in paediatric obstructive sleep apnoea patients before and after adenotonsillectomy. From all paediatric patients who presented to our OPD with complaints of mouth breathing and snoring, a subset of patients fulfilling our inclusion criteria were selected and evaluated with PSQSRBD scale, quality of life (QoL) inventory and PSG level-III. Later37 patients who had moderate to severe OSA were selected for study and underwent adenotonsillectomy. They were further followed up postoperatively at 3 months and 7 months with PSQSRBD Scale and QoL inventory. The study cohort had 37 patients with moderate to severe OSA, with a mean age of 8yrs.The postoperative (mean of 3rd and 7th month) values of PSQSRBD Scale and QoL inventory values was significantly (p < 0.001) reduced compared to preoperative Values after adenotonsillectomy. There is statistically significant correlation between adenoid and tonsil size to the relief of symptoms (PSQSRBD SCALE values) and improvement of quality of life. In our study, surgical (adenotonsillectomy) intervention has significant effect in management of moderate to severe non syndromic paediatric OSA patients.

Cholesteatoma Classification: Review of Literature and Proposed Indian Classification System-TAMPFIC.

Classification systems provides a tool for segregating cases based on their similarities. It can be used by healthcare professionals for representation, comparison, communication, discussion and for standardizing treatment protocols across the geographical boundaries. Cholesteatoma is prevalent in developed as well as developing nations posing a great burden on economic and health sector. Even though systems for classification of cholesteatoma are already being used in some places, however none of them is yet universally accepted due to their complex nature. After a thorough review of the most popular systems, we attempt to propose an Indian classification system for cholesteatoma "TAMPFIC". The system is based on clinical representations and will allow us to standardize the reporting of the disease and its extension along with all possible complications in a simple and unique way and will also help in reporting surgical outcomes for the same. Reporting of surgical outcomes will not only help in comparison but will also help in standardizing treatment protocols for similar kind of cases in future. It will require multi centric approach for validating our system to reach a common consensus for defining treatment protocols. We hope this system acquires universal acceptance and presents itself as a single new tool for classification of cholesteatoma with international consensus in near future.

New Visionary in Upper Airway Surgeries-THRIVE, a Tubeless Ventilation.

THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies.

Hearing Loss-a Camouflaged Manifestation of COVID 19 Infection.

The symptomatology of novel Severe Acute Respiratory Syndrome Corona virus type 2 infection runs the entire gamut of mild to moderate and serious illness among the affected individuals. As listed in recent literature, respiratory, cardiovascular, gastrointestinal, olfactory and gustatory systems are commonly involved. With the growing knowledge about the disease, varied manifestations have been identified and lately, otorhinolaryngology dysfunctions in COVID 19 have been described. Hearing loss in COVID era is one of the emerging areas of concern and calls for further research in the field for the better understanding and treatment of this entity. This study was designed to assess the audiological profile among 100 mild to moderately affected COVID-19 individuals, so as to make a contribution to the emerging literature on otologic manifestations in COVID 19. In our case series, high frequency hearing loss and referred OAE was noted among significant number of COVID 19 positive patients. This was even observed in patients without any otologic symptoms. Hence, early identification and intervention if required helps to give a better quality of life to the patient.

Evaluation of Dynamic CT Scans and Analyzing Its Efficacy Accuracy in Staging of Laryngeal CA: A Prospective Analysis of 30 Patients and Review of Literature.

Laryngeal and hypopharyngeal cancer is the most common cancer in the head and neck. It is the most commonly reported human malignancy, with more than 100,000 cases reported annually worldwide. Thus, exact staging of the tumor is of utmost importance in the decision making of the management of these patients. CT can directly evaluate penetration of tumor into the laryngeal soft tissues and cartilages; whereas laryngoscopy and contrast laryngography can only infer deepseated abnormalities from changes in surface contour of the laryngeal cavity. The main aims of our study were: (1) To assess whether dynamic CT scans increase the diagnostic efficacy for laryngeal and hypopharyngeal cancers and its extent in surrounding structures. (2) To assess the importance of phonation CT scans in evaluation and diagnosis of vocal cord paralysis/fixity and involvement of subglottic region and pre epiglottic space.

Laryngectomy With or Without Partial Pharyngectomy: A Systematic Review.

Complications following the total laryngectomy with or without partial pharyngectomy with neck dissection for laryngeal and pyriform fossa malignancies like aspiration, pharyngocutaneous fistula wound infection, flap necrosis, haematoma, chyle fistula and carotid blowout can cause serious implication on the final outcome of the treatment, which leads to increased postoperative morbidity, hospital stay and hospital cost. A prospective study in the Department of Otolaryngology and Head-Neck Surgery, JSS Hospital, Mysore, from November 2014 to July 2016. 30 patients undergoing Total laryngectomy with or without partial pharyngectomy for laryngeal and pyriform fossa were included in this study. The presentation, diagnosis, and management of the complications that were occurred, were discussed. The age of the patients vary between 32 and 76. Also, male preponderance was seen with approximately M:F ratio 3:1. Out of these 30 patients, 6 patients developed complications. The most common complication was pharyngocutaneous fistula (2 patients, 6%), which was developed after the 7th day. It was managed conservatively in both patients, wound infection was a second complication (2, 6%). Other complications were drain failure (1, 3%) and chylous fistula (1, 3%). The Most common complications after total laryngectomy with or without partial pharyngectomy with neck dissection in our study were wound infection and pharyngocutaneous fistula. Assessment of risk factors, early recognition of complications per operative protocols with improvised techniques are necessary to reduce incidence of complication after total laryngectomy with or without partial pharyngectomy with neck dissection.

Correlation of Primary Tumour Size and Central Compartment Lymph Nodes Metastasis in Well Differentiated Thyroid Malignancies in a Tertiary Care Centre.

Central compartment lymph nodes are the first to be involved in thyroid carcinoma and associated with higher chances of recurrence. (1) Recurrence and revision surgery can be associated with a high risk of vocal cord paralysis and hypocalcemia. (2) However, the need for central compartment lymph nodes dissection routinely in all cases of thyroid malignancies is controversial considering the risk to recurrent laryngeal nerve and parathyroids. (3) The aim of the study was to evaluate the incidence of central compartment lymph nodes metastasis in well differentiated thyroid malignancy and their correlation with size of the primary tumour along with incidence of postoperative hypocalcemia and recurrent laryngeal nerve injury after central compartment lymph node dissection. Observational study 30 patients diagnosed as well-differentiated thyroid carcinoma after fine needle aspiration cytology and planned for total thyroidectomy and central compartment lymph node dissection in the Department of ENT at a tertiary care hospital in Mysuru were studied. After surgery, histopathological examination (HPE) of thyroid and lymph node specimen was done. Postoperatively, all patients were evaluated for hypocalcemia and recurrent laryngeal nerve injury. The incidence of central compartment lymph node metastasis after HPE was 66.6%. 80% cases with tumor size ≤ 1 cm and 64% cases having tumor size > 1 cm showed central compartment lymph node involvement. Overall Incidence of transient Hypocalcaemia was 40%. No case of recurrent laryngeal nerve palsy was observed. In well-differentiated thyroid malignancies we found a high incidence of central compartment lymph node involvement which was even higher with primary tumour of smaller size (≤ 1 cm). We did not find any incidence of permanent hypocalcemia and recurrent laryngeal nerve injury. So based on our study we emphasize on elective central compartment lymph node clearance to avoid recurrence.

Drug-Induced Sleep Endoscopy as a Selection Tool for Surgical Management of Obstructive Sleep Apnoea Syndrome: Our Personal Experience.

The role of Drug-induced sleep endoscopy as a selection tool for surgical management of obstructive sleep apnoea syndrome. SOURCE OF DATA: Polysomnography proved OSA patients, who are planned for surgery in dept. of ENT AND HEAD& NECK, JSS Hospital, Mysore. STUDY DESIGN: A prospective clinical study. METHOD: 30 Polysomnography proved OSA patients, age between 20 and 60 years have been selected for Drug Induced Sleep Endoscopy (DISE) after taking informed consent for proposed surgery. Inj propofol infusion given throughout the DISE procedure and upper airway nasal endoscopy performed for assessment of site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (circumferential, lateral) and severity of obstruction, Lowest SpO2, apnoeic episodes and DISE findings were recorded. Out of these thirty patients 90% were male and 10% were female, observed that 66.7% of males and 40.7% of females belonged to 31-40 age group, and BMI of 63.3% of patient population were overweight, 20% were obese and 5% were normal. Mean fall in SpO2 was 90.20 ± 2.77 in normal subjects, 83.05 ± 5.14 in overweight subjects and 68.83 ± 9.11 in obese subjects. Normal subjects had 0.4 ± 0.9 apnoeic episodes, overweight subjects had 0.9 ± 1.6 episodes and obese subjects had 4.0 ± 2 apnoeic episodes. We observed that 40% had retropalatal airway collapse, 23.3% had airway obstruction at the base of the tongue, 20% had airway obstruction with floppy epiglottis, 12% multiple level collapse, 6.7% of patient population had grade 4 enlarged tonsils, 3.3% had lateral pharyngeal wall collapse, and 0% hypopharyngeal collapse. Out of 30, 29 Patients underwent surgery (Expansion sphincter pharyngo plasty-14, Hyoid advancement-4, Uuvulopalatoplasty-10, Epiglottic surgery-6, Zeta pharyngoplasty-2, midline glossectomy-3, Endoscopic septoplasty-5, Inferio turbinoplasty-2, LASSER Assisted lingual tonsillectomy-1), All these 29 patient were followed for 3 months, at the end of 3rd month again Each subject was evaluated with a baseline Epworth Sleepiness Scale and LEVEL-3 PSG, the results were impressive with statistically significant. DISE is a dynamic, safe, and easy-to-perform technique that visualizes, the anatomical sites of snoring or apneas for assessment site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (Circumferential, Lateral) and severity of obstruction and guides the design of a tailor-made treatment plan for a OSA SURGEON in individual cases, which will improves perioperative outcome.

Recurrent inverted papilloma of paranasal sinus presenting as acute proptosis.

Objective. To describe the course of events that followed from the time of the diagnosis to the management of a rare case of recurrent inverted papilloma presenting as an acute proptosis. Methods. A seventy-year-old diabetic female patient presented with a painful left eye proptosis for 15 days. She had a history of resection of inverted papilloma of paranasal sinus followed by radiotherapy for eight years before. The examination revealed a 23 mm proptosis, with restricted ocular movements, corneal oedema, funnel shaped anterior chamber, and total retinal detachment with a complete visual loss. The lobulated fixed hard mass was palpable circumferentially but more in the inferior orbital compartment. The transconjunctival incisional biopsy showed features of highly undifferentiated cytology. The lid sparing exenteration was done under general anesthesia with cosmetic reconstruction. Results. Immunohistochemistry of exenterated mass was doubtfully suggestive of a small cell tumor. However, histopathology confirmed features of rhabdomyosarcoma. Conclusion. The present case study revealed rhabdomyosarcoma cytology presenting as an association-inverted papilloma. Abbreviations : IP = Inverted papilloma, PNS = Paranasal sinus, SCC = Squamous cell carcinoma, IOP = Intraocular pressure, CT = Computed tomography.