Paediatric Type I Cartilage Tympanoplasty with or without Concomitant Adeno-tonsillectomy – An Institutional Experience

Introduction                                                                           In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process.                                    Materials and Methods                                                          A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy.                                                                   Results                                                                                              Graft uptake was 86.4% in Group 1 at 6 months post-operative follow up while that in Group 2 was found to be 86.5%. The mean hearing gain in two groups were found to be 15.91±6.54 dB and 17.02±8.96 dB respectively. No significant difference was found between graft uptakes and hearing gains in two groups at the end of the study.                                                  Conclusion                                                                              Type I cartilage shield tympanoplasty, may be considered as an effective management strategy of paediatric chronic otitis media, mucosal disease. Type I tympanoplasty with concomitant adeno-tosillectomy did not prove to be better than type I tympanoplasty alone in terms of anatomic closure of tympanic perforation and hearing gain

Extensive Mucosal Erosion and Sloughing of Tongue: A Hitherto Unknown Complication of Topical Clotrimazole Preparation

Clotrimazole, a broad-spectrum imidazole antimycotic, is a widely-used prescription as well as an over-the-counter drug for treatment of mucosal (oral, vulvovaginal) candidiasis and dermatophytes. An extremely safe and well-tolerated drug, its safety profile has been well-explored in researches and trials. The commonest complaints are almost always non-serious-pruritus, rashes, paraesthesia (stinging/burning sensation) and erythema on topical applications, and nausea, vomiting, unpleasant taste sensation and elevated liver enzymes on oral preparations (troches). However, mucosal ulceration on topical clotrimazole preparation has not been reported in literature before. We present here the first documentation of extensive bilateral erosions and necrosis of tongue involving the mucosa, submucosa and musculature on application of one percent weight/volume clotrimazole mouth paint in a 27-year-old immunocompetent woman who presented with oral candidiasis. Keywords: extensive bilateral ulceration and necrosis; oral candidiasis; side effect; topical clotrimazole

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

Study Of The Performance Of A Rotary Kiln Of A Cement Manufacturing Industry Using Pid Controller

A theoretical study has been carried out to find the performance of a rotary kiln in a cement manufacturing industry, where PID controller has been used to control the quality of the clinker. This is done by finding the transfer function, steady state errors due to application of different types of input signals, such as unit step, unit ramp, and parabolic and frequency response of the whole system. The overall gain of the system is found out and numerical calculations and results are simulated using \u27MATLAB\u27 software

Laryngopharyngeal Reflux Disease - Do Prokinetic Drugs have any Role in Management?

Abstract Objectives : 1. To diagnose laryngopharyngeal reflux disease (LPRD) clinically with the available subjective screening protocols (RefluxSymptomIndex and Reflux Finding Score) to categorize the disease based on its severity. 2. To evaluate the role of Prokinetic drugs in the treatment ofLPRDas a whole&in different disease severity groups.   Methods : A hospital-based interventional study was performed for a period of 5 months in patients presenting with symptoms suggestive of LPR in the outpatient department of R G Kar Medical College. The history was taken in detail and symptom scoring was done in terms of REFLUXSYMPTOMINDEX. Then fiber-optic laryngoscopic assessment was done in each patient and REFLUX FINDING SCORE was obtained. Reflux Finding Score over 7 was considered to be suggestive of LPR. The patients were then categorized to three severity groups. In each group, patients were randomly assigned to be treated with either pantoprazole with domperidone or with pantoprazole only. They were followed up at 1 &3 months from initiation of treatment&assessed for improvement by using same criteria, RSI&RFS.   Results : High female preponderance was noted for LPR. Mostly the middle aged (30-50 years) persons were affected. Disease severity was almost the same in both sexes but symptom scores were much higher in females, particularly in extremes of ages. The commonest presenting symptom of LPR was found to be lumpy or sticky sensation in throat and common signs were laryngeal erythema, edema & posterior commissure hypertrophy. Laryngeal erythema was not found to be a reliable marker of disease severity but laryngeal edema & posterior commissure hypertrophy were. Focal vocal fold edema was a more consistent marker of disease severity than diffuse edema, especially in lower symptom group. Addition of prokinetic drugs in the management of LPRD was found to be satisfactorily effective. In refractory cases, reflux inductiondiet was prescribed, which worked quite well.   Conclusions : Prokinetic drugs are effective adjunct to pantoprazole in the management of LPRD. Keywords: Laryngopharyngeal reflux; RFS; Prokinetic drugs; Induction reflux diet

Quantitative Assessment of voice by Acoustic Analysis in patients undergoing Microlaryngeal Surgery for vocal cord nodules

Abstract Objective: To assess the usefulness of acoustic analysis of voice in patients undergoing microiaryngeal surgery at R.G Kar Medical College and to support the current practice of subjective voice evaluation in such patients. Methods: A prospective observational study was carried out at R.G. Kar Medical College involving 17 patients undergoing microiaryngeal surgery for benign vocal cord lesions in the department of Otorhinolaryngology. Using Dr. Speech software, pre-operative and 6 weeks post-operative acoustic analysis of voice of each patient was done and the data thus collected was statistically analysed and evaluated. Results: Astatistical significant change occurs in the basic voice parameters postoperatively.Meanfundamental frequecy changed from 226.40 to 198.60, mean standard deviation of fundamental frequency changed from 3.18 to 2.50, mean jitter from 0.56 to 0.37, mean shimmer from 4.43 to 3.00, Singnal to noise ratio (SNR) from 16.48 to 20.98 and Harmonic to noise ratio (HNR) from 16.5 to 20.57. These changes reflect an improvement in voice quality, hoarseness and roughness with lesser perturbations during speech. Conclusion: Voice is amulti-dimensionalmodality. Perceptual evaluation of voice by itself is not sufficient.Acoustic analysis of voice shouldbeusedby surgeons to supplement theperceptual analysis in bothpre-operative andpost-operativeperiod. Keywords: Acoustic analysis; micro Laryngeal surgery; post-operative assessment

Tuberculous retropharyngeal abscess presenting with dysphagia in a young adult male already on anti-tubercular therapy

Tuberculosis is known to affect almost every organ in the body, but its manifestations in the head and neck region are quite rare. Retropharyngeal abscess (RPA) caused by tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis within the head and neck. Here we present an unusual case of tuberculosis retropharyngeal abscess causing dysphagia in a young adult male already on anti-tubercular therapy, with neither any evidence of tuberculosis involvement of cervical spine nor any pulmonary tuberculosis lesion