Sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media

Background: Chronic Suppurative Otitis Media (CSOM) is the major cause of hearing impairment, mainly conductive type of hearing loss. The occurrence of sensorineural hearing loss (SNHL) in CSOM is controversial and the controversy is more for safe mucosal type. This study aims to assess the association between SNHL and safe mucosal CSOM and its relation to patient’s age, sex, duration of disease, active or inactive disease and speech frequencies.Methods: 100 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The infected ear was taken as study ear and normal ear as control ear in all patients. All patients underwent hearing assessment by pure tone audiometry for both ears. In case of active disease, ear discharge was first cleared and then audiometric assessment done. Results were statistically compared in all patients for both study and control ears using parameters of patient’s age, sex, duration of disease, speech frequency and active or inactive disease.Results: There was significant higher number of study ears with CSOM having average bone conduction threshold of all frequencies above 25 decibels which implies SNHL (21%) compared to control contralateral ears without infection (5%). There was higher incidence of SNHL at higher speech frequencies. The incidence also increased with age of patient and duration of disease. The incidence was higher in active stage than inactive or quiescent stage. There was no difference among males and females.Conclusion: Safe mucosal CSOM can cause significant SNHL and risk increases with increasing age, duration of disease, higher speech frequencies and presence of active disease.

Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity

Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy

Role of Honey in Post operative Tonsillectomy Cases

ABSTRACT Introduction: Honey has been used since ancient times for healing of skin wounds and preventing infections. The aim of this study is to evaluate the effect of honey on pain, infection and wound healing in post operative tonsillectomy cases. Materials and Methods: 40 patients planned for tonsillectomy under general anaesthesia were taken up in the study. 20 patients in the study group were given oral honey post operatively along with other medication whereas remaining 20 patients in control group were not given oral honey. Patients were evaluated post operatively after 1, 2, 7 and 14 days for post operative pain, healing of tonsillar fossa wound, post operative bleed, fever, recovery time, patient satisfaction and other criterias. Results: The results showed that pain was much lesser in study group. There was better wound healing, shorter recovery time with greater patient satisfaction. There were lesser post operative complications like fever with lesser need for intramuscular analgesics. No specific side effects of honey were noted. Conclusion: So it can be concluded that honey can be considered as a complementary medicine in post operative tonsillectomy cases

Fat Graft Myringoplasty- Day Care Procedure: Role in Small Central Perforations

Introduction: Day care surgery is the need of hour in the field of otology. Temporalis fascia is the most common material used for closure of tympanic membrane perforation. But it is a lengthy procedure requiring general anaesthesia (GA) or longer sedation, extensive middle ear manipulation and a longer recovery post operatively. Fat is said to have angiogenetic properties. The aim of this study is to evaluate the usefulness of adipose tissue fat for closure of dry small perforations of tympanic membrane as a day care procedure. Materials and Methods: 40 patients with small central dry tympanic membrane perforations were taken up for surgery under sedation using fat graft from ear lobule for closure of perforations. The results were evaluated inta operatively, immediate post operatively and at 1st, 4th , 8th and 12th monthly post operative visit for uptake of graft, hearing improvement and complications of the procedure if any. Results: The results showed that the graft uptake success rate`was high as good as traditional myringoplasty using temporalis fascia. The procedure was minimally invasive, requiring little sedation, taking much less time, cost effective where both ears can be operated in the same sitting and the patients can be discharged on the same day with no major complications. There was considerable hearing improvement noted in the patients in the study. Conclusion: So it can be concluded that fat graft myringoplasty is an effective method for closure of small central dry tympanic membrane perforations

Measuring and improving customer retention at authorised automobile workshops after free services.

Customer retention is vital for businesses with much research literature now available. But nothing has been investigated regarding measuring and improving customer retention at authorised automobile workshops after free services. Even after providing extensive warranties and other free service benefits, customers don’t use authorised workshops although their vehicles are still under warranty. By not arranging regular maintenance services, customers lose warranty benefits, with product performance and safety related awareness undermined; companies lose huge business potential. Therefore, this study aims to measure and improve customer retention at authorized automobile workshops after free services. To achieve this, a four-phased study has been conducted. In phase one, a combination of a literature review and expert opinions is used to identify customers’ retention factors. The second and third phases describe how data is collected from industry experts and customers. Analytical Hierarchy Process (AHP) and Decision Making Trial & Evaluation Laboratory (DEMATEL) are used to prioritise and examine inter-relationships among factors. In the last phase, the study recommends three business strategies to help a company to improve customer retention and make their Annual Maintenance Contract (AMC) product more customer friendly.N

Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity

Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy