Pre- and Postoperative High-Speed Videolaryngoscopy Findings in Adductor Spasmodic Dysphonia Following Transoral CO2 LASER-Guided Thyroarytenoid Myoneurectomy.

INTRODUCTION: Vocal cord vibration after transoral CO2 LASER-guided thyroarytenoid (TA) myoneurectomy in adductor spasmodic dysphonia (AdSD) patients is unclear to date. The precise vibratory patterns in AdSD patients are difficult to evaluate with routine videolaryngostroboscopy. High-speed videolaryngoscopy (HSV) is an ideal choice to evaluate such patients. This study was performed to compare pre- and postoperative, after 6 months, vocal fold vibratory onset delay (VFVOD) and closed phase glottal cycle (CPGC) in AdSD patients following transoral CO2 LASER-guided TA myoneurectomy using the HSV. MATERIALS AND METHODS: Retrospective study, conducted from January, 2016 to January, 2019, of the AdSD patients who underwent transoral CO2 LASER-guided TA myoneurectomy using the HSV. Patient data were acquired from the hospital database to evaluate VFVOD and CPGC from HSV recordings of the patients. VFVOD was calculated as sum of prephonatory delay (PPD) and steady-state delay (SSD). The PPD and SSD were evaluated and compared separately for each patient. The MedCal Version 19.2.6 was used for data analysis. Paired sample t test was performed to compute the significance of the difference between the mean of the dataset. A P value less than 0.05 was considered significant. RESULTS: A total of nine patients were included in the study, out of which three were females and six were males. The average age was 45.5 ± 6.9 years. The mean of postoperative PPD (166.8 ± 22.1), SSD (76.5 ± 8.6), and CPGC (62.6 ± 4.8) were significantly less than mean of preoperative PPD (222.6 ± 22.1), SSD (97.7 ± 9.5), and CPGC (71.6 ± 5 %), with P values of 0.0007, 0.0001, and 0.0001, respectively. CONCLUSIONS: There was a significant decrease in VFVOD and CPGC posttransoral CO2 LASER-guided TA myoneurectomy in AdSD patients after 6 months follow-up. This study also establishes efficiency of the HSV to measure the vocal cord vibration in the patients with AdSD. The primary limitations of the study were the small sample size and its retrospective nature. Future prospective studies with increased sample size can further substantiate the findings of the work performed here.

Long term Follow Up of Severe Laryngomalacia Patients Following CO2 LASER Supraglottoplasty.

Laryngomalacia is the most common cause of stridor. It is believed to be due to delayed development of the supraglottic structures. On the basis of presentation, it has been divided into 3 grades. Management is dependent upon the grades: Mild and moderate laryngomalacia are managed conservatively, while CO2 LASER supraglottoplasty is the surgical management of choice for severe disease. In this study we evaluated the outcomes of supraglottopasty in long term follow up. It was a retrospective study which included patients with severe laryngomalacia who have undergone supraglottoplasty for the dates from July 2013 to July 2018. Weight and height of the patients were taken during the follow up visit after one year and have been compared with that of the normal children of comparable age using the pediatrics growth charts. Follow up was done by telephonic conversation to evaluate the status of other symptoms associated with laryngomalacia. Total of 44 patients were included in the study, 47.7% and 52.3% females and males respectively. Weight for age, weight for height and height for age were normal in 80.9%, 80.9% and 76.1% of patients respectively after supraglottoplasty. Of the patients studied, stridor was resolved in 80.9%, early tiredness during play was resolved in 43.2%, swallowing was normal in 85.7% and there was no aspiration in 90.5%. It can be concluded that patients with severe laryngomalacia improved with respect to airway symptoms, as well as, weight and height on long term follow up after CO2 LASER supraglottoplasty. It is important to evaluate the general status of the patients as a whole to truly assess the success of the surgery in addition to the airway symptoms.

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases.

To prepare safety protocols for performing videolaryngoscopy (VLS) during COVID-19 pandemic, that would be feasible for patients, hospital and the health care providers. This was a prospective study performed from March 01, 2020 to June 30, 2020. It analyzed the precautions adapted for VLS initially and subsequently describes modifications with the time. The safety protocols are developed considering the safety aspect, the feasibility aspect (due to increase in number of the VLS), and the financial aspect. The VLS was performed with the personal protective equipment (PPE), including the face shield mask and head cover. The PPE was re-used after sterilization with ethylene oxide. For local anesthesia, the oropharynx was sprayed with 15% xylocaine and nose packed with 4% xylocaine soaked pledget. Following the VLS, the scope was wiped three times with 80% alcohol and then immersed in 5.25% sodium hypochlorite and 0.55% ortho-phthalaldehyde for 10 min each. Each VLS was spaced by at least 15 min gap. The endoscopy suite maintained with laminar air flow. It can be concluded that during the COVID-19 pandemic, the VLS must be performed using PPE with proper sterilization of the scope and the endoscopy suite after the procedure. The use of face shield mask and 15% xylocaine spray into the oropharynx were also highlighted. The financial burden should be minimized by reusing the materials whenever possible.

Study of Hearing Status in COVID-19 Patients: A Multicentered Review.

To evaluate the hearing status of COVID-19 patients and compare with control group. Prospective study carried out in 9 institutes. The pure tone audiogram and impedance audiometry of COVID-19 patients performed initially and at 3 months follow up. The control group consisted COVID-19 negative individuals with no history of ear related diseases. The average of air and bone conduction threshold (AC and BC) were compared between the COVID-19 patients and control group using independent t-test with a p value of less than 0.05 considered significant. Total of 331 patients, age 32 ± 4.3 years, 66.7% males and 33.3% females were included in the study. There were 80 individuals in the control group. Aural symptoms were, tinnitus in 1.8%, aural fullness in 1.4%, hearing loss in 3. 9%, and ear ache in 1.8% were present initially, resolved at 3 months follow up. The impedance audiometry demonstrated type B and type C curve in 5.1% and 1.15% ears, and out of these 64.7% and 40% improved at 3 months follow up respectively. No significant difference observed between the average AC and BC of the COVID-19 patients and control group. The COVID-19 infection may present with aural symptoms; however, it was concluded that there was no significant difference in the hearing status of the COVID-19 positive patients in comparison to the control group. The presence of some changes in the normal functioning of the eustachian tube and middle ear in the COVID-19 infection was also highlighted.

Smell and Taste Disturbance in COVID-19 Patients: A Prospective Multicenteric Review.

To study the incidence of the smell and taste disturbance in the COVID-19 patients and a follow up at 4 months to observe for the duration of resolution of these symptoms. This is a multicentric prospective study carried out in 3 different countries, from April, 2020 to January, 2021. The COVID-19 positive patients, aged between 15 and 60 years, were inquired about the presence of any smell or taste related symptoms. The same patients were followed up with the telephonic interview after 2 months and then after 4 months, respectively. The duration of resolution of the smell and taste disturbance symptoms was noted. Total of 188 COVID-19 positive patients, average age 33.1 ± 1.7 years, 54.2% males and 45.8% female were included in the study. The smell disturbance was present in 60.6% (hyposmia 36.1%, anosmia 20.2%, and parosmia 4.2%) and taste disturbance in 28.7% of patients (hypogeusia 20.2%, ageusia 6.9%, and parageusia 1.6%). There was improvement of anosmia by 97.4, hyposmia by 95.6%, parosmia by 100%, ageusia by 100%, hypogeusia 94.8%, and parageusia by 66.7%, at 4 months follow up. The present study concludes that the smell and taste disturbances are one of the main early presenting features of the COVID-19 infection. The temporary effect of the COVID-19 infection on the olfactory and gustatory pathway was also highlighted with more than 95% patients improving at 4 months of follow up.

Pre- and post-operative high-speed videolaryngoscopy in unilateral vocal cord paralysis following autologous fat augmentation.

PURPOSE: To compare high-speed videolaryngoscopy (HSV) parameters such as open quotient (OQ), amplitude symmetry index (ASI), phase symmetry index (PSI), and frequency symmetry index (FSI), of the unilateral vocal cord paralysis (UVCP) patients pre and post (after 6 months) autologous fat augmentation. MATERIALS AND METHODS: This retrospective study evaluated all age and gender patients with UVCP that underwent autologous fat augmentation from July 2016 to July 2019. The OQ, ASI, PSI, and FSI were calculated from the HSV recordings by using the montage and fast Fourier transform point analysis. The pre-and post-operative means were compared using a paired student t-test, with a p-value less than 0.05 considered significant. RESULT: A total of 37 patients, age 41.2 ± 11.3 years (21 to 67 years), 59.4% females and 40.6% males, were included in the study. The average duration of symptom onset was 2.3 ± 0.87 months. The post-operative mean values of OQ, ASI, PSI, and FSI following the fat augmentation were significantly improved compared to the pre-operative mean values with p-values <0.0001, 0.0018, 0.0011, and 0.0006, respectively. CONCLUSION: There was a significant improvement in the OQ, ASI, PSI, and FSI in UVCP patients after 6 months of autologous fat augmentation, signifying an enhanced vibratory function. The ability of HSV to measure the minute details of vocal cord vibration by providing quantitative measurements has also been highlighted. The need for future prospective research with an increased sample size and longer duration of follow up is recommended.

High-speed videolaryngoscopy in early glottic carcinoma patients following transoral CO2 LASER cordectomy.

PURPOSE: To compare high-speed videolaryngoscopy (HSV) findings, like open quotient (OQ), vocal fold vibratory onset delay (VFVOD), amplitude symmetry index (ASI) and phase symmetry index (PSI), after 6 months of cordectomy with that after 1 year, and to compare later with the control group. METHODS: Retrospective analysis of HSV recordings of 33 patients of early glottic carcinoma after cordectomy was performed after 6 months and 1 year of cordectomy with the help of videokymogram and digital kymogram. The control group of ten individuals was selected from patients who came to hospital with complaints other than larynx. The comparison was done for different types of cordectomy separately. RESULTS: The mean of OQ, VFVOD, ASI and PSI was found to be significantly higher after 6-month follow-up than after 1-year follow-up, the later was in turn found to be significantly higher than that of the control group, for type II and III cordectomy. The mean of OQ, VFVOD, ASI and PSI for other types of cordectomy also showed similar results, but the significance was not calculated due to less sample size. CONCLUSION: There was significant improvement in OQ, VFVOD, PSI and ASI following CO2 LASER cordectomy after 1 year of follow-up, making it a good management option for early glottic carcinoma. The ability of the HSV to measure variations in the vocal cord vibration, following cordectomy, was well established by this study.

Comparison of Microbiological Flora in the External Auditory Canal of Normal Ear and an Ear with Acute Otitis Externa.

INTRODUCTION: Acute Otitis Externa (AOE) is also known as swimmer's ear. Investigations initiated during World War II firmly established the role of bacteria in the aetiology of Acute Otitis Externa. AIM: To culture the microbiological flora of the normal ear and compare it with the flora causing AOE and to know the role of normal ear canal flora and anaerobes in the aetiology. MATERIALS AND METHODS: A prospective observational study was conducted on 64 patients clinically diagnosed with unilateral AOE. Ear swabs were taken from both the ears. Microbiological flora was studied considering diseased ear as test ear and the normal ear as the control. Aerobic and anaerobic cultures were done. Severity of the disease was assessed by subjective and objective scores. Effect of topical treatment with ichthammol glycerine pack was assessed after 48 hours and scores were calculated again. Patients with scores < 4 after pack removal were started on systemic antibiotics and were assessed after seven days of antibiotics course. Data was analysed using Paired t-test, Wilcoxon signed ranks test and Chi-square test. A p-value < 0.05 was considered significant. RESULTS: Pseudomonas aeruginosa (33%) was the most common bacteria cultured from the ear followed by Methicillin Resistant Staphylococcus aureus (MRSA) (18%). Patients with anaerobic organism in the test ear had severe symptoms and needed systemic antibiotic therapy. CONCLUSION: Most of the cases may respond to empirical antibiotic therapy. In cases with severe symptoms and the ones refractory to empirical treatment, a culture from the ear canal will not be a tax on the patient. This helps in giving a better understanding about the disease, causative organisms and helps in avoiding the use of inappropriate antibiotics that usually result in developing resistant strains of bacteria.

Smooth muscle tumour of uncertain malignant potential (SMTUMP) in the nasal cavity: an incidental finding.

Sino-nasal smooth muscle tumours of uncertain malignant potential (SMTUMP) are very rare neoplasms of mesenchymal origin with features in between a benign leiomyoma and a leiomyosarcoma. We report a rare case of SMTUMP in a 44-year-old woman, who presented with vague symptoms of pharyngitis. Nasal endoscopy revealed a smooth mass in left nasal cavity. Contrast-enhanced CT and MRI scans showed features likely to be inverted papilloma or olfactory neuroblastoma or meningioma. Excision was planned and intraoperatively, frozen section revealed a probable spindle cell lesion. Final histopathological report following immunohistochemistry (IHC) & immunofluoresence (IF) confirmed it to be a SMTUMP. This patient underwent complete resection via endoscopic KTP laser assisted, anterior skull base surgery with no recurrence on follow-up.