Study of the Reliability of High Resolution CT Scan Evaluation of Eustachian Tube as Predictor of Predisposition for Chronic Otitis Media.

Eustachian tube (ET) dysfunction is one of the predisposing factors for chronic otitis media (COM). This study looks at two parameters in High Resolution Computed Tomography of temporal bone namely tubotympanic angle (TTA) and pretympanic diameter (PTD) and its relationship with COM. The objectives of the study were to compare the tubotympanic angle and pretympanic diameter of the affected ear in patients with unilateral COM with that of healthy controls, and with contralateral non-COM ear. This was a retrospective study done at a tertiary referral hospital. Database of patients who underwent high resolution CT scan of temporal bone over a period of  three and half years, was studied. The TTA and PTD of ET were measured with the help of a senior radiologist well-versed in the imaging of temporal bone. Group A consisted of 45 patients with unilateral COM, while Group B comprised 50 patients without COM. Group A was further subgrouped as A1 (COM with cholesteatoma) and A2 (COM without cholesteatoma). The TTA and PTD in COM with cholesteatoma in the affected ear were 147.98 ± 5.89° and 2.84 ± 0.82 mm respectively, and in the unaffected ear, 144.81 ± 6.43° and 3.32 ± 1.19 mm respectively. In Group A, the TTA and PTD in the affected ear of unilateral COM were 146.17 ± 6.11°, 2.97 ± 0.87 mm and in Group B, it was 143.17 ± 6.01° and 3.48 ± 0.85 mm respectively. All these were statistically significant (p value < 0.05). Increased TTA and reduced PTD of ET may be a predisposing factor for the development of COM and cholesteatoma.

Pilot of a questionnaire study regarding perception of undergraduate medical students towards online classes: Process and perspectives.

BACKGROUND: The COVID-19 pandemic situation has forced a shift in medical education from physical classroom to virtual online teaching. However, students and teachers perceive this differently. It is important to study these perceptions to improve the teaching-learning process, and thus to validate the role of online learning in the country. OBJECTIVE: To document the process of a pilot for a questionnaire-based study regarding perception of undergraduate medical students towards on-going online classes. METHODS: Medical Education Department of a teaching hospital developed a new questionnaire with the primary objective of studying the satisfaction and usefulness of the online classes (e-Learning). Content validity was done. For the pilot work, 10% of the total student strength was targeted. Random purposive sampling from each phase of the undergraduate course was done to choose the participants. The questionnaire was administered via Google Classroom. It was an external, undeclared type of pilot. All the responses were documented and analysed for both changes in the questions as well as for statistical sample size derivation for the main study. RESULTS: Responses from 30 students were analysed for the pilot study. Based on the proportion of the level of satisfaction (23.3%) and usefulness (23.3%) of the on-going online classes observed, and with 20% relative precision and 95% confidence, the minimum sample size for the main study was calculated. The responses revealed the need for minor changes in the questionnaire tool for overall feasibility and achievement of the objectives of the main study. CONCLUSIONS: A pilot study is a necessary component for a research project, especially when it involves the use of a new tool. This paper shows the relevance of the same. The authors intend to convey the importance of documenting the processes of conduct of a pilot study, the issues involved therein, and the steps taken to resolve the same.

Perceptions of undergraduate medical students regarding institutional online teaching-learning programme.

BACKGROUND: Medical education all over the country has been forced to shift to e-learning, mainly online classes. In this scenario, the medical education department (MEU) of a teaching hospital under a deemed university felt the need to study the satisfaction and usefulness of these classes, as perceived by the undergraduate medical students. METHODS: Questionnaire survey was planned. A specially designed questionnaire was created, keeping in mind, the study objectives. It was validated, and a pilot was conducted, for modifications and to calculate sample size. The questionnaire was administered by email as Google Forms. The responses, which included quantitative and qualitative responses, were analysed, and feedback points noted. Percentage level of satisfaction and usefulness was calculated with 95% confidence interval. To test the statistical significance of the association of satisfaction levels amongst students of different Phases, chi square test was used. RESULTS: On a scale scoring for satisfaction, 53.6% scored moderate, 31% high, and 15.4% low satisfaction. 49.8% of the students were less satisfied about attending classes from home; 15.7% felt it was better. 57.1% of the students found the concept of online learning moderately useful, 31.4% found it minimally useful, 11.5%, highly useful. CONCLUSIONS: The undergraduate medical students perceived moderate satisfaction and usefulness with the on-going online classes. They expressed the desire to resume routine physical classes, especially for practicals and clinics. Points of improvement of the online teaching-learning programme were also obtained. This study revealed sufficient feedback to be shared with all stakeholders, regarding improvements in the online classes.

Prevalence of Voice Disorders in School Teachers in a District in South India.

BACKGROUND: Many professions tend to carry inherent risks for the practitioners. In such cases, it becomes mandatory for them to be aware of the risks and counselled about the preventive measures. The inevitable first step, however, is to ascertain the burden of risk. In the case of school teachers, it is known that they are prone to voice disorders of varying hues, at some point of their career. There should be an attempt to find the prevalence in the community. Presently, there is no such data documented from Kerala, a highly literate State in southern India. AIM AND OBJECTIVES: The primary objective of this study was to document the prevalence of subjective dysphonia among the school teacher community. The secondary objective was to compare the prevalence and severity of dysphonia between primary and secondary school teachers. MATERIALS AND METHODS: A cross-sectional study was conducted in 28 schools, using a screening questionnaire, based on similar ones used in other studies. All the schools were in the city of Kochi, the largest and most populous metropolitan area in Kerala. Teachers reporting a current voice complaint at the time of study were administered the validated vernacular version of the voice handicap index questionnaire (VHI 30). The completed questionnaires were collected and statistically analyzed. RESULTS: The screening questionnaire was administered to 702 teachers; 165 were Primary school teachers (Class I-V), 242 Secondary (Class VI-XII), while 279 teachers had to take classes in both sections. The reported prevalence was 45.4% for present difficulty related to their voice, 52.8% for some voice problem in the last 1 year, and 70.1% for problems experienced during the duration of their teaching career. Possible risk factors like age, total years of teaching, hours of daily teaching and number of students taught did not show any significant association with voice problem. CONCLUSIONS: Nearly, half of all the screened school teachers reported a current voice problem, increasing to nearly three-fourths for symptoms during entire career. This is clearly a significant burden which must be addressed at various levels. The secondary school teachers seem to bear a bigger burden in this study.

Usefulness of a modified questionnaire as a screening tool for swallowing disorders in Parkinson disease: A pilot study.

AIMS: To determine the correlation between our questionnaire scores and two standard Parkinson's disease (PD) disability scores [Unified Parkinsons' Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y)], and to study the correlation between the various subgroups of our dysphagia screening questionnaire. SETTINGS AND DESIGN: This study was conducted at a movement disorder clinic in a tertiary care hospital in Kochi, Kerala. This was a cross-sectional observational study. MATERIALS AND METHODS: A questionnaire was developed comprising 11 items, keeping in mind the most relevant swallowing issues in PD patients. The questions were subdivided into four groups representing the different stages of swallowing. Reliability and validity studies were conducted for the questionnaire. Corresponding UPDRS and H and Y scores were documented on the same day. STATISTICAL ANALYSIS USED: Mean and standard deviation (SD) values of the scores in each group and the correlation between scores (Pearson correlation coefficient) were done. RESULTS: Responses were obtained from 106 PD patients (67 males, 39 females), with a mean age of 66.9 years (SD, 8.62). Our questionnaire score showed a high coefficient of variation (145%) compared to the UPDRS and H and Y scores. There was also moderate correlation between our questionnaire score and the two standard scores with a significant P value. Finally, the highest mean scores were for questions from group A and the least for questions from group D. CONCLUSIONS: The association between worsening motor symptoms and swallowing difficulties has been documented in this study. The oral stage of swallowing remains the most affected in PD, which can be recognized early using our questionnaire.

Construction of a 3D Model of Epitympanic Folds and Spaces.

This article reports a technique for making a 3 dimensional(3D) model of the epitympanic folds and spaces in the middle ear. It is intended as a teaching model for both undergraduate and post-graduate medical students.

A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia: A pilot study.

BACKGROUND: As with most neurologic conditions, stroke involves impairment of the swallowing mechanism. This could be a spectrum of issues, the worst of which is aspiration. At the same time, the prolonged presence of a naso-gastric tube (NGT) has its own morbidity. Flexible endoscopic evaluation of swallowing (FEES) is one reliable method to assess the structural and functional status of the oropharynx and larynx, during the swallowing process. OBJECTIVE: To study the utility of FEES in decision-making with respect to resumption of oral intake in stroke patients. To document the findings of FEES in stroke patients, and to look for correlations between these and the site of stroke. MATERIALS AND METHODS: Protocol insertion of naso-gastric tube in all stroke patients, at presentation. Initial assessment by a neurologist and swallowing therapist, depending on cognitive status of the patient. All patients underwent MRI Brain with diffusion weighted sequences. After detailed clinical examination, they underwent swallow exercises under the supervision of a trained swallowing therapist. The decision to remove NGT was taken clinically by the combined decision of neurologist and swallowing therapist. Then all patients underwent FEES by the ENT surgeon. The final decision for NGT removal was taken as per the FEES findings. RESULT: Sixteen stroke patients underwent the FEES procedure during a period of six months. The oropharyngeal and laryngeal findings varied depending on the area of stroke involvement. Of these, change in decision regarding swallowing rehabilitation or NGT removal was needed in four patients, following the FEES findings. CONCLUSIONS: FEES is an easy, efficient and reliable method to evaluate the swallowing status in stroke patients. In combination with good bedside clinical examination and swallow exercises, it can be a good tool in assessing patients with post- stroke dysphagia. Post-stroke rehabilitation and prevention of aspiration pneumonia can be effectively done with the help of FEES.

Etiology and Anti-microbial Sensitivity of Organisms Causing Community Acquired Pneumonia: A Single Hospital Study.

OBJECTIVE: The objective of this study was to identify the common etiological pathogens causing community acquired pneumonia (CAP) in our hospital and sensitivity patterns to the common antibiotics used. MATERIALS AND METHODS: This study was undertaken in a 750 bedded multi-specialty referral hospital in Kerala catering to both urban and semi-urban populations. It is a prospective study of patients who attended the medical out-patient department and those admitted with a clinical diagnosis of CAP, during the year 2009. Data were collected based on detailed patient interview, clinical examination and laboratory investigations. The latter included sputum culture and sensitivity pattern. These were tabulated and percentage incidence of etiological pathogens calculated. The antimicrobial sensitivity pattern was also classified by percentage and expressed as bar diagram. RESULTS: The study showed Streptococcus pneumoniae to be the most common etiological agent for CAP, in our hospital setting. The other organisms isolated in order of frequency were Klebsiella pneumoniae, Pseudomonas aeruginosa, Alpha hemolytic streptococci, Escherichia coli, Beta hemolytic streptococci and atypical coli. S. pneumoniae was most sensitive to linezolid, followed by amoxicillin-clavulanate (augmentin), cloxacillin and ceftriaxone. Overall, the common pathogens causing CAP showed highest sensitivity to amikacin, followed by ofloxacin, gentamycin, amoxicillin-clavulanate (augmentin), ceftriaxone and linezolid. The least sensitivity rates were shown to amoxicillin and cefoperazone. CONCLUSION: In a hospital setting, empirical management for cases of CAP is not advisable. The present study has shown S. pneumoniae as the most likely pathogen and either linezolid or amikacin as the most likely effective antimicrobial in cases of CAP, in our setting.

Suprahyoid pharyngotomy for excision of laryngeal venous malformation.

We report an uncommon case of symptomatic venous malformation of the larynx in a 22-year-old man, and the successful surgical management thereof. A detailed radiologic investigation of the lesion was done, followed by surgical excision via a suprahyoid pharyngotomy using cold instruments. Long-term follow-up was maintained, and the patient had subjective and objective resolution of his symptoms and signs at 3 years postoperatively. We conclude that radiology can reveal hitherto unsuspected extensions of vascular malformations in the neck and that surgical excision is a viable mode of treatment in upper aerodigestive venous malformations.