Conventional versus Flap Tracheostomy: Operative Simplicity, Stomal Care, Complications

Introduction Tracheostomy is a life saving procedure and its operative principle has withstood the test of time although the operative techniques have evolved. Inferiorly based flap on the anterior tracheal wall (Bjork flap) was demonstrated in 1952. The present study aims to compare conventional tracheostomy with flap tracheostomy. Materials and Methods A Randomized Control Trial was conducted in a tertiary care teaching medical institute comparing conventionally tracheostomised patients (Group A) with the group where flap based method was followed (Group B). Results The study population was comprised of 110 patients with equitable distribution in the groups. Per-operative time to establish an airway was measured and statistically correlated. 9.26% patients of Group A had difficult tube change, with none in Group B. Ease of stomal care by the patient and family members (Visual Analogue Scale), depicted it to be “very easy” in 76.36% of the patients in Group B and 16.36% in Group A. Stomal healing in first week was proper in 61.82% of patients in Group A and 80% of the patients in Group B. Tracheo-cutaneous fistula (TCF) developed in 18.18% of the adult and geriatric patients of Group A undergoing stomal closure. None of the patients in Group B had TCF following stomal closure. Conclusion Establishing Bjork flap tracheostomy is equally quick making the process suited for emergency situations. Flap based tracheostomy has early stomal maturation so, care of the stoma by health assistants and family members is easy

Audio-Vestibular Manifestations in COVID-19; A Systematic Review and Meta-analysis

Introduction Audio-Vestibular (AV) presentation as a consequence of COVID-19 is a less ventured zone. The aim of the study was systematically review the literature (both studies and case reports) published up to August 2021, in order to provide evidence on audio-vestibular symptoms in SARS-CoV-2, COVID-19 patients. Systematic review and meta-analysis was performed for assessment of prevalence of AV symptoms among COVID-19 patients. Materials and Methods A search of existing literature using key words and MeSH (Medical Subject Headings) terms was done. The methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 36 qualitative studies were narratively synthesized. Meta-analysis was performed on 18 quantitative studies Results Hearing loss was most commonly reported AV manifestation among case series / case reports. In the quantitative studies, the pooled estimate of Hearing loss, Dizziness and Tinnitus was 4.558%, 4.226% and 5.513% respectively. Other reported AV symptoms included ear ache, aural fullness and facial paresis. Conclusion Prevalence of AV symptoms in COVID-19 differs from that of the published literature. This prevalence of hearing loss is less than that reported amongst the world population. Structured community-based studies with homogeneous working definitions have to be conducted to assess the true prevalence

Audio-Vestibular Manifestations in COVID-19; A Systematic Review and Meta-analysis

Introduction Audio-Vestibular (AV) presentation as a consequence of COVID-19 is a less ventured zone. The aim of the study was systematically review the literature (both studies and case reports) published up to August 2021, in order to provide evidence on audio-vestibular symptoms in SARS-CoV-2, COVID-19 patients. Systematic review and meta-analysis was performed for assessment of prevalence of AV symptoms among COVID-19 patients. Materials and Methods A search of existing literature using key words and MeSH (Medical Subject Headings) terms was done. The methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 36 qualitative studies were narratively synthesized. Meta-analysis was performed on 18 quantitative studies Results Hearing loss was most commonly reported AV manifestation among case series / case reports. In the quantitative studies, the pooled estimate of Hearing loss, Dizziness and Tinnitus was 4.558%, 4.226% and 5.513% respectively. Other reported AV symptoms included ear ache, aural fullness and facial paresis. Conclusion Prevalence of AV symptoms in COVID-19 differs from that of the published literature. This prevalence of hearing loss is less than that reported amongst the world population. Structured community-based studies with homogeneous working definitions have to be conducted to assess the true prevalence

A Rare Variety of Adenoid Cystic Carcinoma involving Submandibular Salivary Gland

Introduction Adenoid cystic carcinoma, an uncommon malignant salivary gland neoplasm, is known for its long clinical course, indolent growth, neural invasion, local recurrence and late distant metastasis. Three distinct histological patterns have been identified, amongst which, solid pattern is the rarest one having the worst prognosis. Materials And Methods A case of sixty year old male patient presented with a swelling in the left side of the neck, below the jaw gradually enlarging during the last three years. FNAC from the neck swelling was suggestive of benign adenoma of the salivary gland, possibly basal cell adenoma or pleomorphic adenoma. Submandibular gland was excised. Histopathological examination confirmed the solid pattern of adenoid cystic carcinoma, which is the rarest among the three distinct histological subtypes of the malignancy. Discussion Adenoid cystic carcinoma is well known for its perineural spread. In cases of submandibular gland adenoid cystic carcinoma, surgical wide excision is very much possible and in T1 or T2 cases post-operative radiotherapy may not be needed. In our case, post operative radiotherapy was given for best local control, as the tumour showed histopathlogical solid variety, grade III pattern, which is known to have the worst prognosis

An Arrow Penetrating the Globe and the Sinonasal Complex

Introduction: Foreign bodies represent on average 11% of all ENT emergencies. Associated eye trauma represents 5% of all cases of blindness in developing countries. Accidental and homicidal arrow injuries presenting to an otorhinolaryngologist are still a stark reality in this modern era. Case report: A 22 year-old female presented with an accidental arrow injury in her left eye; extending into the nose. On examination, she had no light perception in left eye and a penetrating injury of the sclera. CT scan showed extensive injury to ipsilateral nasal cavity, floor of left orbit and the maxillary sinus and anterior ethmoid cells. Multidisciplinary approach ensured removal of the unusual foreign body from the orbit, nose and paranasal sinuses. Discussion: Accidental injury in ear, nose or throat with sharp projectiles presents a challenge. Arrowhead may be poisoned and thus exploration is delayed until the systemic effect of the poisoned is reduced. An injury such as this involves a multidisciplinary approach. As ENT surgeons we must be aware such challenges and equip ourselves with the knowledge to tackle them

Universal Neonatal Hearing Screening - a Necessity and not a Choice

INTRODUCTION Congenital deafness in a child is often missed. Several distraction tests have evolved over time to diagnose congenital deafness. These are of limited value in the era of Evoked response audiometry. Evoked responses, such as Oto-acoustic emission (OAE) and Brainstem Evoked Response Audiometry (BERA) have played a significant role in early diagnosis of congenital hearing impairment. The study was conducted to compare the result of neonatal hearing screening in high risk and non high risk neonates. MATERIALS AND METHODS A study was conducted over a time period of three months at a tertiary care institute to screen all live neonates for congenital hearing impairment using OAE and BERA. RESULT 1182 neonates were screened for hearing impairment. 336 were in High risk group and rest in Non high risk group. Nine neonates turned out to have abnormal BERA result (absence of wave V). Six of them were high risk babies and rest 3 were non high risk. DISCUSSION 33.33% of congenital deaf population detected by UNHS belong to the Non High Risk group. Studies across the world suggest at least 50% chance of missing out a congenital deaf child if Universal Neonatal Hearing Screening is not practiced.   CONCLUSION In order to ensure that early detection and effective intervention are made on all newborns with hearing impairment, UNHS should be performed. Three stage UNHS protocol using TEOAEs and BERA showed that the implementation of UNHS for congenital childhood hearing loss among all newborns in India feasible and effective

Recurrent Acute Tonsillitis, The 'Core' Issue

Introduction: Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.  Materials and Method: A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically. Result: There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre. Discussion: The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks. Conclusion: Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population