Prevalence of Voice Disorders in Indian Female Secondary School Teacher Population-A Cross Sectional Study.

Teachers are the backbone of any civilized society as they are the keepers of knowledge, wisdom and values. Lack of infrastructure, manpower and resources makes voice the most important tool for a teacher. Teachers need to speak loudly for long periods often under unfavourable circumstances. Increased vocal effort and incorrect phonation techniques can lead to vocal fold tissue damage and vocal fold pathologies and hence voice problems producing adverse effects on teaching performance. To study the prevalence of voice disorders in Indian female secondary school teacher population. To identify the risk factors for the development of voice disorders. A multicentric, cross-sectional observational study of 200 teachers were conducted in 4 schools over a period of 2 years. Female teachers who gave consent and were willing for follow up were included in the study. Details were collected using a structured questionnaire. Subjective analysis by VHI, perceptual analysis by GRABS score, acoustic analysis and direct visualization using Hopkins 70° rigid laryngoscope were done.The prevalence of voice disorders was 18.5%. Risk factors identified were age group 41-60 years, repeated respiratory allergies, comorbidities, constitutional symptoms, increased number of years of teaching and number of lecture hours per week. VHI, GRABS, Acoustic analysis findings were consistent with Rigid Laryngoscopic finding making them effective tools in the assessment of voice.

Effects of Insulin-Like Growth Factor (IGF-1) in Patients with Sensorineural Hearing Loss.

OBJECTIVES: (1) To test the effect of local administration of insulin-like growth factor-1 (IGF-1) in patients with sensorineural hearing loss (SNHL). (2) To test the effect of local administration of IGF-1 in patients with ototoxicity. METHODS: Forty patients with SNHL were included in the study. Their hearing thresholds at different frequencies (0.5, 1, 2, and 4 kHz) along with the average hearing threshold were noted. The patients were then randomly allocated to 2 groups and were treated with IGF-1 via one of the following routes: (1) intratympanic injection and (2) Gelfoam. Patients were followed-up at weekly intervals for 6 weeks but follow-up PTA was done at 3 weeks, 6 weeks, and 6 months only. RESULTS: Forty patients (25 male, 15 female) participated in the study. Their age ranged from 13 to 63 years, with a mean of 31.3 years. Nineteen (47.5%) patients exhibited some degree of recovery after 6 months of follow-up, while 21 (52.5%) did not exhibit any recovery. Fourteen (35%) patients showed slight recovery (SR), 1 (4%) patient showed marked recovery, and complete recovery was observed in 4 (10%) patients. Twelve of the 20 patients who underwent treatment using Gelfoam showed improvement in hearing (measured as a reduction in hearing threshold), while only 7 of the 20 patients who underwent intratympanic injection showed such improvement. Among adverse reactions, the most common was pain (88%) which typically did not last beyond 3 days. Other adverse reactions observed were dizziness (24%) and headache (20%). One patient suffered from acute suppurative otitis media (ASOM) and had a perforation in the tympanic membrane. However, this was treated successfully with medications. CONCLUSION: Intratympanic IGF-1 is a novel drug that has shown early promise in controlling and reversing SNHL.

Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System.

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

Impacted Incus Foreign Body in the Eustachian Tube.

INTRODUCTION: Foreign bodies in the external auditory canal are fairly common, and tend to be seeds, toys, or insects. However, foreign bodies in the middle ear are rarer and are generally accidental or iatrogenic. Although there are numerous reports regarding fascinating foreign bodies in the ear, the same cannot be said about foreign bodies in the Eustachian tube (ET). CASE REPORT: A 20-year-old male patient presented with right-sided active squamosal chronic otitis media (COM) persisting for 10 years. An incidental finding of a hyperintense foreign body (FB) located near the isthmus of the right ET was reported on high-resolution computed tomography (HRCT) of the temporal bones. The FB was bony (eroded incus), which was impacted near the isthmus of the ET and was extremely difficult to remove. A natural FB such as an eroded ossicle in the ET which aggravated the adhesive otitis and caused active squamosal COM has not been reported in the literature. CONCLUSION: We have reported this case not only for its rarity but also to make readers aware of such incidental findings which can be found only by imaging, and to suggest how they can be tackled with current equipment and technology.

Aberrant innominate artery may complicate a potentially safe surgery.

Surgeries of the anterior neck include thyroid surgery, open or percutaneous dilatational tracheotomy, bronchoscopy, mediastinoscopy and oesophagoscopy. These are potentially safe surgeries with mortality rates less than 1%. Today, the most common cause of death following a tracheotomy is haemorrhage and, following thyroid surgery, the causes are haemorrhage, giant goitres and upper airway complications. Bronchoscopies and mediastinoscopies are almost never fatal. While operating around the trachea, no major vessel is encountered in the surgical field. We report a case in which an aberrant innominate artery was encountered crossing anterior to the trachea just below the thyroid isthmus. As it is an uncommon finding, even minor complacency can lead to torrential bleeding culminating in death. Thus, we recommend surgeons to be vigilant for any aberrant artery in the surgical field rather than finding it accidentally; thereby preventing any complications in a potentially safe surgery.