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Apoorva KV, Vijendra Shenoy S, Athiyamaan MS, Kabekkodu S, Kshithi K, Zuturu N. Radiation dose to the cochlea and its association with sensorineural hearing loss in head and neck cancer-A prospective study. Am J Otolaryngol 2023; 44:103914. [PMID: 37178536 DOI: 10.1016/j.amjoto.2023.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
AIM To determine the effect of cochlear dose on sensorineural hearing loss in patients with head and neck cancer treated by radiotherapy and chemoradiotherapy. MATERIALS AND METHOD A two-year longitudinal study was conducted on 130 subjects with various head and neck malignancies who were receiving radiotherapy or chemoradiation. 56 patients received only radiotherapy while 74 patients received concurrent chemoradiation five days a week at a dose of 66-70 Gy. They were categorized as having a radiation dose to the cochlea of <35 Gy, <45 Gy or >45 Gy. Pre- and post-therapy audiological evaluation was done using a Pure-tone audiogram, distortion product otoacoustic emission, and impedence. Hearing thresholds were measured at frequencies up to 16,000 Hz. RESULTS Out of 130 patients 56 received RT alone and 74 received CTRT. There was statistically significant (p value <0.005) difference in Pure-tone audiometry assessment in both the RT and CTRT groups between subjects who received more than and <45 Gy of radiation to the cochlea. There was no significant difference in distortion product otoacoustic emission assessment between patients who received >45 Gy and <45 Gy radiation to the cochlea. Comparison between subjects who received radiation dose of <35 Gy and >45 Gy revealed significant results in the degree of hearing loss (p value <0.005). CONCLUSION We observed that patients who received >45 Gy of radiation had more sensorineural hearing loss compared to patients who received <45 Gy. A cochlear dose of <35 Gy is associated with significantly lower hearing loss compared to higher doses. We would like to conclude by emphasizing the importance of regular audiological assessments prior to and post radiotherapy and chemoradiotherapy, with regular follow-ups encouraged over a longer period to improve the quality of life in patients with head and neck malignancy.
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Affiliation(s)
- K V Apoorva
- Dept of ENT and Head & Neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - S Vijendra Shenoy
- Dept of ENT and Head & Neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - M S Athiyamaan
- Dept of Radiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sushmitha Kabekkodu
- Dept of ENT and Head & Neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Kshithi
- Dept of ENT and Head & Neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Neehal Zuturu
- Dept of ENT and Head & Neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Kasaragod SK, Kshithi K, Parvathareddy N, Sriperumbudur S, Shenoy SV. Unusual Presentation of Otoacariasis: A Prospective Study at Referral Teaching Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:4345-4349. [PMID: 36742573 PMCID: PMC9895631 DOI: 10.1007/s12070-021-03023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Otoacariasis is the presence of ticks and mites within the ear canal. Though the coexistence of ticks and humans is known for thousands of years, tick infestation is relatively rare in urban population. The most common presenting symptoms are usually itching, otalgia and a foreign body sensation and less frequent ones are tinnitus and otorrhoea. We report cases of otoacariasis with unusual presentation. A total of 43 cases presented to the ENT clinic in our hospital over a period of three years from 2018 to 2021. We present patients who presented with unusual symptoms of conductive hearing loss, ear bleed, and facial palsy. Total of 6 cases of otoacariasis had unusual presentation. 2 cases presented with lower motor neuron palsy, 1 case with ear bleed, and 3 cases with hearing loss. Otocariasis can present with unusual symptoms of hearing loss, ear bleed or facial palsy and this should be included in the differential diagnosis of a patient with history of close proximity to domestic or wild animals. Detailed examination often reveals the presence of the tick and identification and complete removal along with appropriate medication for associated symptoms often results in complete recovery.
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Affiliation(s)
- Sreenivas Kamath Kasaragod
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka India
| | - K. Kshithi
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka India
| | - Navya Parvathareddy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka India
| | - Sushmita Sriperumbudur
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka India
| | - S. Vijendra Shenoy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka India
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Shenoy V, Kasaragod SK, Usmani SA, Mulkys V, Kshithi K, Kumar N. Prophylactic Glycopyrrolate Administration to Aid Otolaryngology Residents in Prevention of Post-laryngectomy Pharyngocutaneous Fistula. Indian J Otolaryngol Head Neck Surg 2022; 74:2643-2648. [PMID: 36452678 PMCID: PMC9702210 DOI: 10.1007/s12070-020-02362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022] Open
Abstract
Pharyngocutaneous fistula (PCF) after laryngectomy occurs when there is a failure in the pharyngeal repair resulting in a salivary leak (Dedivitis et al. in Acta Otorhinolaryngol Ital 27(1):2-5, 2007). In the post-operative period this complication is not only a challenge to the surgeon but also distressing to the patient and his family. We conducted a retrospective cum prospective study, to research the effect of starting prophylactic glycopyrrolate intravenous injection in total laryngectomy. Fifty patients underwent total laryngectomy with modified radical neck dissection over a period of 5 years by the trainee otolaryngologists. Of these 25 patients were started on glycopyrrolate for 7 post-operative days. And 25 control patients, who were not given glycopyrrolate. All the patients were observed for evidence of PCF. Of the total 50 patients, only 1 patient in study group and 12 patients in the control group developed PCF. This was statistically significant (p value 0.0039). Tumor stage, site, and gender were found to have no statistically significant correlation with development of PCF. The prophylactic administration of glycopyrrolate was found to reduce the odds of development of PCF in total laryngectomy cases. There was associated blurring of vision and constipation amongst the cases subjects, which was only transient with complete recovery on cessation of drug.
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Affiliation(s)
- Vijendra Shenoy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sreenivas Kamath Kasaragod
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Shahab Ali Usmani
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Vasudha Mulkys
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - K. Kshithi
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
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Kshithi K, Kini J, Dosemane D, Banerjee S. Spindle cell carcinoma masquerading as a benign polyp of the soft palate. J Cancer Res Ther 2022; 18:804-806. [DOI: 10.4103/jcrt.jcrt_617_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Angiectatic sinonasal polyps are uncommon. However, riveting nature of this polyp lies in its clinical presentation mimicking a neoplasm. It is radiologically very challenging to pick up this lesion in spite of its characteristic findings on imaging. Histopathology is paramount for asserting diagnosis. We report a rare case of a patient who presented to our outpatient department with chief complaints of nasal block, nasal discharge, and epiphora for 6 months. On examination, a mass was found filling the left nasal cavity. Computed tomography scan and diagnostic nasal endoscopy were suggestive of fungal sinusitis or sinonasal malignancy as a differential diagnosis. Biopsy was reported as benign sinonasal polyp. The patient underwent endoscopic resection of the mass, which on histopathology revealed the diagnosis of an angiectatic sinonasal polyp.
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Affiliation(s)
- Shobha Guntur
- Department of ENT and Head and Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Vijendra S Shenoy
- Department of ENT and Head and Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - K Kshithi
- Department of ENT and Head and Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Haneesh Amit Domah
- Department of ENT and Head and Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - G V Chaithra
- Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Kshithi K, Vijendra Shenoy S, Panduranga Kamath M, Sreedharan S, Manisha N, Khadilkar MN, Kamboj V, Bhat JS. Audiological profiling in postmenopausal women with osteoporosis. Am J Otolaryngol 2018. [PMID: 29530429 DOI: 10.1016/j.amjoto.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To compare the audiological profiles in postmenopausal women with and without osteoporosis and to study the pattern of hearing loss in osteoporotic patients. MATERIALS AND METHODS 80 postmenopausal women were evaluated at a tertiary referral center and were divided into normal, osteopenic and osteoporotic based on BMD results. The hearing evaluation was done using PTA, Impedance audiometry and DPOAE and the results were compared between the groups and analyzed. RESULTS Osteoporotic patients had higher incidence of sensorineural hearing loss than normal and osteopenic patients and the results were statistically significant (P ≤0.001) on PTA and DPOAE testing. The mean pure tone thresholds were significantly higher in osteoporotic patients in comparison with normal and osteopenic patients. The average hearing loss in osteoporotic patients with sensorineural loss was of mild degree. CONCLUSION The data reveal that osteoporosis is associated with sensorineural hearing loss in postmenopausal women. The underlying mechanism needs further research but cochlear dysfunction could be an important factor.
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