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

Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists

Introduction Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management. Materials and Methods  An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study. Results The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis. Conclusion Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management

Asymptomatic Middle Ear Dysfunction in Children with Upper Respiratory Infection – Analytical Cross Sectional Study

Introduction Otitis Media with Effusion (OME) is the commonest cause of hearing difficulty and one of the most frequent reasons for elective admission to the hospital for surgery during childhood. The condition starts with dysfunction of middle ear due to poor ventilation through Eustachian tube or extension of the inflammatory process from nasopharynx. In the natural history of the disease, there may be a period of the pre-clinical stage without symptoms or signs of OME. If the disease is identified in this stage, the further sequel of it (like persistent hearing difficulty or retraction pocket formation) may be prevented. Materials and Methods A hospital based analytical cross-sectional study was conducted among the children below 12 years of age to assess the middle ear function (by tympanometry) in children having upper respiratory tract infection (but no ear related complaints) and comparing them with the middle ear function in children not having such infection or any recent history of the same. Age and sex matched control group having no such symptoms was constructed. There were 25 children in both study and control group selected from Otorhinolaryngology and Pediatrics outpatient department (OPD). So total numbers of children were 50. Results  There was no statistically significant difference in background characteristics (age, sex) of the of study and control groups. There was no statistically significant difference when the tympanic membrane retraction or middle ear pressure is taken into account. But significant difference found in the parameters like middle ear compliance (68% children have low compliance in the study group vs 20% in control, with df= 1, ϰ2 = 11.688 and p value was 0.001) and tympanogram curve type (48% in study group have B or C type and 8% have such in control group). Conclusion Early diagnosis of the middle ear dysfunction among the children with upper respiratory infection, by clinical examination and suitable audiological investigation in the pre-clinical stage with appropriate intervention can prevent further progression of the disease, causing hearing loss as well as retraction pocket formation

Large Neurilemmoma of Buccal Mucosa in a Child – A Rare Entity

Abstract: Introduction: Neurilemmoma or Schwannomas are benign tumour arising from the nerve sheath of myelinated nerve. Head neck neurilemmomas are not uncommon but intraoral region is very uncommon for this type of tumour. Case Report: A very rare case of buccal neurilemmoma in an eleven year old child, but much larger than other reported case is reported in the present article with review of literature. Discussion: Among the intraoral subsites, very few cases of neurilemmoma are reported to be situated in the buccal mucosa. Diagnostic dilemmas due to Fine needle aspiration cytology with features often resembling that of pleomorphic salivary adenomas are reported. The size of the tumour was larger than the cases reported in literature till date. The age of the patient was also much younger than the other reported cases, which made the present case unique

Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists

Introduction Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management. Materials and Methods  An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study. Results The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis. Conclusion Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management

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

Clinico-demographic study of otitis media with effusion in different age groups

Background: Otitis Media with Effusion is mainly a disease of childhood. But it can also occur in adults. It can present with various symptoms like difficulty in hearing, blocked sensation in the ear, earache, tinnitus etc. Young children are often diagnosed late due to their inability to express hearing difficulty, and are often diagnosed accidentally. Appearance of the tympanic membrane can also be varying among patients. There may be retraction, dull appearance and change in colour, or reduced mobility. Fluid level or air bubble can also be present in the middle ear behind the tympanic membrane.Aim: To study the demographic profile of the patients diagnosed with OME and to determine the variations in the signs and symptoms of OME in different age groups.Method: This is an observational study. It was conducted on all the patients attending the OPD at a tertiary hospital, and diagnosed with OME over the course of one year. The diagnosis was made after proper history taking and clinical examination and with the aid of audiometry and tympanometry. An effort was made to map out the demographic profile of all the patients diagnosed with OME, and to study the variations in the signs and symptoms of OME across different age groups.Result:In the analysis of parameters it was found that statistically significant higher number of cases were children (< 10 years of age). Number of male was more than female in children but it was equal in adult. Significantly more number of children in the study had bilateral involvement, but in adolescent and adult there was no statistical difference between the incidence of bilateral and unilateral involvement. Difficulty in hearing and heaviness in ears were the two most common presenting symptoms with addition of tinnitus in adult group. Most common appearance of the tympanic membrane was dull in all the ages.Conclusion:In the present study it is evident that the Otitis media with media (OME) is much more common in pediatric population and has a little male preponderance, which corroborates the consensus of the word literature. The present study also corroborates the existing knowledge on some aspect the disease like presenting symptoms (difficulty in hearing and block sensation being the commonest) appearance of tympanic membrane or degree of hearing loss.An effort was made in the present study to compare some aspect of the disease among the patients of different age group.While corroborating most of the issues regarding OME with the existing literature, present study indicates some differences in presentation and diagnostic features in different age groups

Hypothyroidism – An Underestimated Complication After Hemithyroidectomy: A Preliminary Study Report

Introduction Hypothyroidism is a significant but an under-appreciated complication of hemithyroidectomy. The focus of this study was to assess the incidence of hypothyroidism occurring after hemithyroidectomy, identify the risk factors and to suggest a possible follow-up guideline for diagnosis. Materials and Methods An institution based preliminary study was conducted in the Department of Otorhinolaryngology, in a tertiary care hospital, from August 2014 to December 2015 on 25 patients. The patients were regularly followed up in 1st month, 3rd month, 6th month, 9th month and 1 year period with the thyroid function test. Results Incidence of hypothyroidism occurring after hemithyroidectomy including transient and permanent cases is 32%. Increased age of presentation, longer duration of thyroid swelling, pre-operative serum TSH level >2.5 mIU/ml, lymphocytic infiltration in histopathology and right sided hemithyroidectomy were found to be the possible risk factors. Conclusion It is indicated from this preliminary report that there should be a serial thyroid function monitoring in every post-operative hemithyroidectomy patient, and special attention should be given to the risk grou

Asymptomatic Middle Ear Dysfunction in Children with Upper Respiratory Infection – Analytical Cross Sectional Study

Introduction Otitis Media with Effusion (OME) is the commonest cause of hearing difficulty and one of the most frequent reasons for elective admission to the hospital for surgery during childhood. The condition starts with dysfunction of middle ear due to poor ventilation through Eustachian tube or extension of the inflammatory process from nasopharynx. In the natural history of the disease, there may be a period of the pre-clinical stage without symptoms or signs of OME. If the disease is identified in this stage, the further sequel of it (like persistent hearing difficulty or retraction pocket formation) may be prevented. Materials and Methods A hospital based analytical cross-sectional study was conducted among the children below 12 years of age to assess the middle ear function (by tympanometry) in children having upper respiratory tract infection (but no ear related complaints) and comparing them with the middle ear function in children not having such infection or any recent history of the same. Age and sex matched control group having no such symptoms was constructed. There were 25 children in both study and control group selected from Otorhinolaryngology and Pediatrics outpatient department (OPD). So total numbers of children were 50. Results  There was no statistically significant difference in background characteristics (age, sex) of the of study and control groups. There was no statistically significant difference when the tympanic membrane retraction or middle ear pressure is taken into account. But significant difference found in the parameters like middle ear compliance (68% children have low compliance in the study group vs 20% in control, with df= 1, ϰ2 = 11.688 and p value was 0.001) and tympanogram curve type (48% in study group have B or C type and 8% have such in control group). Conclusion Early diagnosis of the middle ear dysfunction among the children with upper respiratory infection, by clinical examination and suitable audiological investigation in the pre-clinical stage with appropriate intervention can prevent further progression of the disease, causing hearing loss as well as retraction pocket formation

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