High expression of CD9 and Epidermal Growth Factor Receptor promotes the development of tongue cancer.

Tongue cancer is distinguished by aggressive behavior, a high risk of recurrence, lymph, and distant metastases. Hypoxia-Induced Factor 1 α functions as a CD9 transcription factor. CD9 is a transmembrane protein that may be found on the cell membrane. It can modulate the expression of the Epidermal Growth Factor Receptor (EGFR) pathway. ELISA was used to measure serum CD9, p-EGFR, and p-Akt levels in 70 tongue cancer patients and 35 healthy controls. RT-PCR was used to analyze the gene expression of the related genes. The gene as well as protein expression of CD9, EGFR/p-EGFR, and Akt/p-Akt was significantly higher in case subjects when compared with the controls. The expression of CD9 was higher in case subjects who were smokers/alcoholics when to control subjects who were smokers/alcoholics. Overexpression of CD9 due to hypoxic conditions leads to the activation of EGFR-signaling pathway resulting in cancer progression, resistance to chemotherapy. Hence, CD9 could be a potential target to suppress cancer progression.

Simulation-based training in ear, nose and throat skills and emergencies.

OBJECTIVES: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. METHODS: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5‒6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. RESULTS: The participants had significant improvement in the post-test scores in all three scenarios (p <  0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p <  0.05). CONCLUSION: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. LEVEL OF EVIDENCE: II.

Simulation-based training in ear, nose and throat skills and emergencies

Abstract Objectives: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. Methods: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5-6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. Results: The participants had significant improvement in the post-test scores in all three scenarios (p < 0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p < 0.05). Conclusion: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. Level of evidence: II.

The effect of functional endoscopic sinus surgery on nasal resonance.

Background and objective: Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings. Methods: The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2. Results: In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua. Conclusion: Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo

Abstract Introduction Benign paroxysmal positional vertigo (BPPV) is one of the common disorders of the peripheral vestibular system. The prevalence of BPPV is found to be higher among middle-aged women. Objectives To estimate the serum levels of calcium and vitamin D in patients with BPPV, and to study their association. Methods The present is a hospital-based prospective case-control study. Venous blood samples of the 49 patients with BPPV and an equal number of age- and gender-matched individuals were recruited and submitted to an analysis of the serum levels of calcium and vitamin D. Results Among the cases, 67.3% were found to be females, and 32.7% were males. Most of the 30 cases (61.3%) were aged >40 years. The mean age of the cases was 44.39 years. The mean serum level of vitamin D in the cases was of 21.26 ng/ml compared with 17.59 ng/ml in the controls. The mean serum level of calcium was of 9.33 mg/dl in the cases, compared with 8.95 mg/dl in the controls. There was no significant difference in the serum levels of vitamin D and calcium between cases and controls. Conclusion We could not establish any correlation between the serum levels of calcium and vitamin D with BPPV. However, a negative relationship was found between the serum levels of vitamin D and the number of episodes of BPPV (p = 0.012).

The Role of Video Head Impulse Test (Vhit) in Diagnosing Benign Paroxysmal Positional Vertigo (BPPV).

Benign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes. General treatment for BPPV is by clinical examination by Dix-Hallpike maneuver, Video head impulse test (VHIT) is a novel test that enhances diagnostic opportunities and enables a clinician to precisely localize the site of vestibular disorders. This interested us to investigate its potential in diagnosis of BPPV.The aim of the present study is to assess the role of Video head impulse test (VHIT) in confirming the clinically diagnosed case of BPPV.All patients above the age of 18 years who were clinically diagnosed with BPPV underwent VHIT and results were correlated with clinical findings. Total 60 patients were studied in the period of 2016-2018.Among the 60 patients clinically diagnosed with BPPV, 41 were males and 19 were females. Majority of patients were in the age group of 51-60 years. Posterior canal is most commonly affected (97%) than anterior and lateral canals in BPPV. In unilateral posterior canal BPPV and bilateral posterior canal BPPV VOR (Vestibulo- ocular reflex) gains was reduced but were not statistically significant. Saccades were present only in 17 cases. There is no relationship between the presence of saccades, the canal involved and the side of the lesion.From the present study we conclude that the currently available equipment for VHIT is not useful in diagnosing BPPV. Also, strongly recommends advanced research on this to record minute changes in VOR gain.

Role of Otoacoustic Emission in Early Detection of Cisplatin Induced Ototoxicity.

Cisplatin is a chemotherapeutic agent effective against head and neck carcinoma but unfortunately it is cochleotoxic. This study has been designed to investigate the efficacy of OAE in identifying early effects of cisplatin on the cochlea and the importance of protocol for audiological monitoring of cisplatin induced ototoxicity. This is a prospective observational study conducted from October 2012 to September 2014 on 70 patients, receiving Cisplatin for various malignant conditions. Audiological criteria for ototoxicity was considered as a difference of 10 d B or more in pure tone thresholds of two or more adjacent frequencies in conventional audiometry and in DPOAE-Signal noise ratio less than 6 dB or DPOAE amplitude less than 20 dBSPL (irrespective of SNR > 6 dB). According to PTA, 60.7% patients showed ototoxicity after completion of chemotherapy. In DPOAE, according to SNR and amplitude criteria more than 60% patients showed ototoxicity after first cycle of cisplatin at high frequencies (4-8 kHz). DPOAEs is a sensitive tool for early detection of ototoxicity and protocol is necessary for monitoring ototoxicity in patients receiving cisplatin to improve the quality of life.

Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo.

Introduction Benign paroxysmal positional vertigo (BPPV) is one of the common disorders of the peripheral vestibular system. The prevalence of BPPV is found to be higher among middle-aged women. Objectives To estimate the serum levels of calcium and vitamin D in patients with BPPV, and to study their association. Methods The present is a hospital-based prospective case-control study. Venous blood samples of the 49 patients with BPPV and an equal number of age- and gender-matched individuals were recruited and submitted to an analysis of the serum levels of calcium and vitamin D. Results Among the cases, 67.3% were found to be females, and 32.7% were males. Most of the 30 cases (61.3%) were aged > 40 years. The mean age of the cases was 44.39 years. The mean serum level of vitamin D in the cases was of 21.26 ng/ml compared with 17.59 ng/ml in the controls. The mean serum level of calcium was of 9.33 mg/dl in the cases, compared with 8.95 mg/dl in the controls. There was no significant difference in the serum levels of vitamin D and calcium between cases and controls. Conclusion We could not establish any correlation between the serum levels of calcium and vitamin D with BPPV. However, a negative relationship was found between the serum levels of vitamin D and the number of episodes of BPPV ( p = 0.012).

A study of Spirometric parameters in non asthmatic allergic rhinitis.

INTRODUCTION: Allergic rhinitis (AR) is a common IgE -mediated inflammatory condition characterised by sneezing, nasal congestion, itching and rhinorrhoea. Nasal allergy is a strong risk factor for the onset of asthma in adults. Bronchial hyper-responsiveness (BHR) is a distinct feature of pathophysiology in asthma. Spirometric parameters like Forced Expiratory Volume in first second [FEV1] and Forced Expiratory Flow [FEF 25-75%] are known to be impaired in patients with allergic rhinitis. We studied these parameters in subjects of AR who have never experienced any chest symptoms. It is well known that, subjects with allergic rhinitis are at greater risk of developing overt bronchial asthma in future. METHODS: All patients presented with symptoms of allergic rhinitis without history of bronchial asthma were included. Patients those who were clinically diagnosed with allergic rhinitis were evaluated with absolute eosinophilic count, serum IgE and Spirometric assessment. In spirometry, post bronchodilator FEV1 reversibility and post bronchodilator FEF 25-75% values were used to assess lower airway abnormalities. RESULTS: Among 61 subjects, 32 were males and 29 were females. The maximum numbers [28] of patients were in 21-35 age group. Absolute eosinophil count was elevated in 38% of patients. 33% of patients showed elevated IgE values above 1000. 43% of patients showed FEV1 reversibility which is a sign of Bronchial hyperreactivity. 5% of patients showed impaired post bronchodilator FEF 25-75% which indicates presence of small airway disease. There was significant correlation between FEV1 reversibility and elevated IgE. CONCLUSION: Impaired spirometric parameters indicate coexistence of bronchial impairment and hence predisposition to progression from allergic rhinitis alone to overt asthma in future. Thus careful evaluation of lower airway has to be done to rule out coexisting subclinical asthma.

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy.

Objective Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and Methods In a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. Results The study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. Conclusion An objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.

A comparative study between haemocoagulase and adrenaline in type 1 tympanoplasty.

INTRODUCTION: Haemostasis is a critical component of ear surgeries, which can be achieved by topical methods including simple manual pressure with gauze or cotton balls soaked with adrenaline, administration of haemostatic agents or vasoconstrictive materials. OBJECTIVE: To compare efficacy of haemocoagulase and adrenaline in attaining middle ear haemostasis in type - 1 tympanoplasty with or without cortical mastoidectomy. To study the effect of haemocoagulase in middle ear. MATERIALS AND METHOD: This is a prospective comparative study conducted in a tertiary care hospital from January 2013 to June 2014. Patients undergoing type 1 tympanoplasty with or without cortical mastoidectomy were divided into two groups. In group A (50 cases), cotton balls soaked in 2 ml Haemocoagulase was used and in group B (50 cases) cotton balls soaked in 2 ml Adrenaline (1:1000 dilution) was used for middle ear haemostasis. The efficacy of haemocoagulase and adrenaline was compared. RESULTS: The mean number of cotton balls used in haemocoagulase group in cases with congested middle ear mucosa was more than those used in the adrenaline group. Duration of surgery was more in haemocoagulase group (65 min) with congested mucosa, compared to adrenaline group (50 min). The mean blood pressure was significantly higher in adrenaline group compared to haemocoagulase group. Postoperative hearing improvement in both groups showed no significant difference with p value 0.694. CONCLUSIONS: Adrenaline is a better middle ear haemostatic than haemocoagulase. However, haemocoagulase can safely be used in patients with hypertension.

Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center.

OBJECTIVE: Malignant otitis externa (MOE) is an uncommon but potentially fatal disease of the external auditory canal. The study aimed at evaluating the demographic profile, coexisting disabilities, clinical presentations, and management of MOE. MATERIALS AND METHODS: This is a retrospective study of patients with MOE who were treated at the Otorhinolaryngology Department of our institution. The case records of patients treated between 2006 and 2013 for MOE were reviewed from the Medical Records Department of the hospital. The details were tabulated in a master chart, and the data were analyzed. RESULTS: Fifteen patients with MOE were treated as inpatients at the Otorhinolaryngology Department of our hospital during the study period. Of these, 12 were males and three were females. Among the 15 patients, 14 were diabetic and one was non-diabetic. Earache was the most common symptom observed in all patients; edema and granulations in the ear canal was the most common sign observed in 12 patients. Pseudomonas aeruginosa was isolated in 11 patients. All patients were managed medically with intravenous antibiotics. CONCLUSION: MOE is a rare but aggressive condition affecting the external ear, which is commonly observed in elderly diabetic individuals. Immune senescence may be the cause of MOE in elderly people. Pseudomonas is the most common causative organism isolated in this condition. Most of these patients can be managed with medical treatment; reserving surgery only for the removal of granulation tissue and for histopathological examination.

Extraosseous ameloblastoma of maxillary gingiva- a case report.

Amelobasltoma is a benign neoplasm of the jaw bones that originate from the odontogenic epithelium. They are more common on the mandible than the maxilla. Rarely such tumours arise outside these bones, when they are termed extraosseous or peripheral ameloblastoma. We report a case of extraosseous ameloblastoma in a 30 year old woman, who presented with a painless lesion on the upper gingiva. The lesion was excised completely and the histopathology was suggestive of extraosseous ameloblastoma.

Primary mucinous carcinoma of buccal mucosa: a rare case report.

Minor salivary gland tumors of oral cavity are very rarely encountered in day-to-day practice. Mucinous adenocarcinoma is very rare, and is commonly seen in elderly males. Palate and buccal mucosa is the commonest site. Wide local excision is the treatment. Histology shows tumor cells floating in pools of mucin, compartmentalized by fibrous tissue. Metastasis is a close mimicker, however with an evidence of negative scan and minor salivary gland proliferation in adjacent tissue diagnosis can be made. Mucin stains and immunohistochemistry can be used to support the diagnosis in problematic cases. We are presenting a rare case of mucinous adenocarcinoma-cheek in a 54-year-old male who came with gradually progressive swelling in the left buccal mucosa since 3 months and after wide excision, no evidence of recurrence was noted in 1 year and 3 months of follow up period.

Comments on 'novel multidrug therapy for disseminated rhinosporidiosis, refractory to dapsone - case report'.

Disseminated rhinosporidiosis can be successfully treated with multidrug therapy. Orally administered drugs can take longer to reach the affected areas in the presence of haemorrhage, oedema and inflammation. Wherever possible, surgical excision followed by drug therapy would be more effective.

Otitis media with effusion in relation to socio economic status: a community based study.

Otitis media with effusion (OME) is the presence of non purulent effusion within the middle ear cleft. The symptoms of this disease are not alarming as in suppurative otitis media. The disease is common in young children. The main symptom of this disease is decreased hearing, which may sometime go unnoticed more so if the parents are not attentive. We conducted a community based study among 1,020 school children of the age group 5-10 years from schools of sub-urban areas of Dakshina Kannada district, Karnataka, to explore the relationship of OME in relation to socioeconomic status. Diagnosis of OME was done by clinical examination and tympanometry. Prevalence of OME was 4.5%. Out of 46 cases, 4% belong to upper class, 26% to upper middle class, 26% to lower middle class, 43% to upper lower class.