Changing Clinical Scenario of Tuberculous Otitis Media: A Case Series.

Tuberculosis is a global health problem. Extrapulmonary tuberculosis remains to be a challenge in the diagnosis and treatment. Tuberculous otitis media being not so commonly diagnosed due to its varied presentation, early diagnosis and treatment remains to be a challenge. The aim of this study is to present the varied and unusual presentations and the importance of histopathological confirmation and new diagnostic tools like CBNAAT (cartridge based nucleic acid amplification test) which aids in the confirmation and to start anti-tubercular treatment (ATT). Five cases of tuberculous otitis media within a period of two years were included in the study. Among the five cases three cases presented with discharging sinuses, one with mastoid abscess and one with tuberculous otitis media with pulmonary origin. All five cases were confirmed with proper histopathological examination and two cases with CBNAAT (cartridge based nucleic acid amplification test) confirmation. Anti-tubercular treatment (ATT) was started and the patients were disease free. Tuberculous otitis media remains to be a rare complication of chronic suppurative otitis media and it has to be kept in mind while treating chronic suppurative otitis media. Classical presentations of tuberculous otitis media are not seen nowadays and the disease extending to the mastoid is the changing trend as the initial presentation. A proper suspicion with confirmation of the disease remains to be the gold standard for diagnosis and for treatment with anti-tubercular therapy.

Disparate Presentations of Retropharyngeal Abscess: An Experience From a Tertiary Care Centre.

To discuss the varied presentations, diagnosis, and prompt management of retropharyngeal abscess for academic importance. A retrospective study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery in Belagavi district of Karnataka. Six cases of varied age group with diagnosis of retropharyngeal abscess were studied during two-year period from January 2019 to January 2021. Thorough assessment of all cases was done which included symptoms at the time of presentation, clinical examination findings, imaging studies and laboratory results, medical and surgical interventions. Six patients (4 males, 2 females) were diagnosed as having Retropharyngeal abscess. Youngest age of presentation was 2 month infant. The most common symptoms at presentation included fever and odynophagia seen in all six patients. The clinical examination revealed bulge in posterior pharyngeal wall in all cases, cervical lymphadenopathy in one case, drooling of saliva in three and stridor in one patient, diffuse neck swelling in two ptatients, and trismus in two patients. Contrast Enhanced Computerized Tomographic (CECT) scanning was performed in five patients and one patient underwent Magnetic Resonance Imaging (MRI). The abscess was surgically drained in all patients and received intravenous antibiotics after which there was significant improvement. Retropharyngeal space infection if left untreated, they carry the potential to cause life-threatening complications and death. Although with availability of broad-spectrum antibiotics, the mortality rate is low, appropriate and successful management requires a thorough understanding of the anatomy of the neck, knowledge of usual causative organisms and appropriate medical and surgical management.

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Prevalence of Chronic Suppurative Otitis Media Among School Children Residing in Rural Area of Belagavi, South India.

To study the prevalence of chronic suppurative otitis media among school children in Belagavi, rural area of South India. A community based descriptive cross sectional survey was conducted in 7 schools of rural areas of Belagavi district in Karnataka over a period of 2 months between 15th July and 15th September 2018. A survey demographic data collection was done on 694 school children aged between 6 and 14 years attending these schools. A detailed history and otoscopic examination was done in the school premises. Data received from the study was entered and statistical analysis was done. CSOM was present in 36 (5.2%) out of 694 students examined among which 22 (6.8%) of them lived in families with overcrowding. H/o cleaning the ear with various materials was given by 27 (7.4%) of them. 29 (9.3%) of them had recurrent respiratory tract infection, 7 students had active disease. The prevalence of CSOM in this study is relatively lower in this part of the rural South India. There is a higher prevalence of safe disease with central perforation than unsafe disease. Recurrent respiratory tract infections and history of cleaning of ear were the predictors of CSOM among school children. There is a need for better knowledge of illness and screening programme for early detection and management.

Does Endoscopic Sinus Surgery (ESS) Retrieve Mucociliary Clearance of Maxillary Sinus: Prospective Study at a Tertiary Care Hospital.

To correlate Saccharin clearance time before and after endoscopic sinus surgery (ESS) in chronic maxillary sinusitis patients. Hospital based prospective study done in the department of otorhinolaryngology at our tertiary care hospital from January 2017 to December 2017. We selected 40 patients based on inclusion and exclusion criteria. Saccharin clearance time was measured by the subjective perception of sweet taste following placement of saccharin pellet over the anterior end of inferior turbinate. It was measured preoperatively and postoperatively after 3 months of ESS and the values are compared with normal uninvolved sinuses of the patients. Out of 40 patients, 26 were male and 14 were female. Normal Saccharin Clearance Time was found to be 9.50 and 9.89 min with a standard deviation of 2.76 and 2.62 on the left and right side respectively. There was no significant difference between right and left side mucociliary clearance values. The respective mean preoperative and postoperative mucociliary clearance values of right and left side together were 39.5 min and 17.6 min among unilateral maxillary sinusitis patients, 49.69 min and 20.87 min among unilateral CRS with polyposis patients, 69.42 min and 25.97 min among bilateral maxillary sinusitis patients, 63.71 min and 24.21 min among CRS with bilateral polyposis patients. ESS not only treats the pathology of paranasal sinuses but also helps in returning the normal mucociliary function.