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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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Dosemane D, Kabekkodu S, Jaipuria B, Sreedharan S, Shenoy V. Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S9-S17. [PMID: 34154970 DOI: 10.1016/j.bjorl.2021.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/25/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Schwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. OBJECTIVE In this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. METHODS Patients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. RESULTS Twenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. CONCLUSION A long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.
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Affiliation(s)
- Deviprasad Dosemane
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
| | - Sushmitha Kabekkodu
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India.
| | - Bhagyashree Jaipuria
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India; Mumbai, Maharashtra, India
| | - Suja Sreedharan
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
| | - Vijendra Shenoy
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Department of Otorhinolaryngology & Head and Neck Surgery, Karnataka, India
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K K, Kamboj V, Sreedharan S, Shenoy S V, Rai T, Kabekkodu S. Effect of formalin fixation on tumour size and margins in head and neck cancer specimens. Acta Otorhinolaryngol Ital 2022; 42:434-440. [PMID: 36541381 PMCID: PMC9793140 DOI: 10.14639/0392-100x-n2185] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Objectives To quantify tumour size and margin shrinkage due to formalin fixation in head and neck cancer specimens and determine its effect on tumour staging and margin clearance. Methods Tumour specimens were measured immediate post-resection and at 24 hours after fixation. Tumour was measured in 2 dimensions and one margin was measured. Shrinkage was categorised as < 10%, 10-20%, and > 20%. Effect of shrinkage on tumour stage and margin clearance were evaluated. Results A total of 50 specimens were analysed. The tumour AP (Anterior Posterior) and SI (Superior Inferior) measurements showed significant shrinkage with a mean difference of 22.93% and 21.69% respectively. > 20% shrinkage was noted in 78% of AP and 58% of SI measurements. Margins showed a mean difference of 25.61%. 84% of margins demonstrated > 20% shrinkage. In all, 46.7% of T3 and 23% of T2 tumours pre-fixation were downstaged to T2 and T1, respectively, post-fixation. Conclusions Formalin fixation alone can be responsible for significant shrinkage of tumour and margin dimensions in head and neck specimens. It is suggested that decisions regarding the treatment plan should be made on clinical staging of primary tumour rather than pathological staging. In addition, post-excision pre-fixation margins should be considered for treatment planning.
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Affiliation(s)
| | | | - Suja Sreedharan
- Correspondence Suja Sreedharan Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India PIN 575001 E-mail:
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Niranjan Khadilkar M, Dosemane D, Mithra P. P, Sreedharan S, Shenoy V, Kabekkodu S, N. Khadilkar U. Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Head and neck is affected in 11-33% of extra-nodal Non-Hodgkin Lymphomas with the Waldeyer’s ring comprising 50% and among which palatine tonsils are most commonly involved.
Materials and Methods: A retrospective analysis was performed using medical case files to study the demographic and clinical details of 13 patients diagnosed with primary lymphoma of palatine tonsil between 2011 and 2020 at a tertiary care hospital in coastal India.
Results: Mean age was 49.7 years with a male preponderance. The usual presentation was either as a unilateral palatine mass or neck swelling with dysphagia, odynophagia and otalgia. All patients had high-grade lymphoma, diffuse large B-cell lymphoma was the commonest type. B-symptoms were seen more often in B-cell lymphoma; stage I was the most frequent. Stage at diagnosis was statistically significant when compared with B-symptoms, bulky disease and International Prognostic Index (IPI) (p-values of 0.02, 0.02 and 0.035 respectively). Overall survival (OS) rate was 44.44%, being higher in females than in males. Higher OS rate was noted for IPI of 1 & 2, and early stage lymphoma, unilateral tonsillar enlargement, normal lactate dehydrogenase, and European Cooperative Oncology Group score of 0. Combined chemoradiation proved to be better (50% OS) than chemotherapy (33.33% OS) alone.
Conclusion: Lymphoma must be suspected in unilateral or bilateral asymmetrical tonsillar enlargement, especially in the older age group. Histopathology with immunohistochemistry plays a crucial role in diagnosis and typing of lymphoma, for proper and early institution of treatment with chemoradiation.
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Kabekkodu S, Sreedharan S, Gupta K, Murali N. Nasal Polyposis in mucopolysaccharidosis type II. BMJ Case Rep 2021; 14:e238778. [PMID: 33674293 PMCID: PMC7939012 DOI: 10.1136/bcr-2020-238778] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/04/2022] Open
Abstract
Mucopolysaccharidosis (MPS) type II is a rare multisystem disorder resulting from the accumulation of breakdown products of glycosaminoglycans in the body tissues. Many patients with this disease undergo ENT (ear, nose and throat) surgeries such as adenotonsillectomy and tympanocentesis at a very early age, much before the diagnosis of MPS. Nasal polyposis is a rare occurrence, with only one case of MPS II with polyposis reported in the literature. We present a patient who presented with recurrent nasal polyposis from the age of 2 years. Hale's colloidal iron was used to stain these 'nasal polyps', which revealed that they are, in fact, mucopolysaccharide-laden sinonasal mucosa prolapsing into the nasal cavities. We believe this is the first time that this stain has been used to stain nasal polyps in MPS. In addition to the histopathological peculiarities of these nasal masses, we also discuss the natural history of nasal polyposis in MPS II.
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Affiliation(s)
- Sushmitha Kabekkodu
- Otorhinolaryngology, Kasturba Medical College Mangalore, Manipal Academy of Higher Eduction, Mangalore, Karnataka, India
| | - Suja Sreedharan
- Otorhinolaryngology, Kasturba Medical College Mangalore, Manipal Academy of Highe Education, Mangalore, Karnataka, India
| | - Kirti Gupta
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirupama Murali
- Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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Khadilkar MN, Pai KK, Rai T, Shenoy V, Dosemane D, Kabekkodu S. Depression profile in malignancy patients attending otorhinolaryngology clinic. Eur Arch Otorhinolaryngol 2020; 278:537-541. [PMID: 32804271 PMCID: PMC7826301 DOI: 10.1007/s00405-020-06289-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/10/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients with malignancy quite often suffer from physical as well as psychological symptoms due to the shattering diagnosis, and prolonged, incapacitating management. The frequency of the depressive disorder in malignancy is around 8-40%. The present study aims at analysing the socio-demographic profile and magnitude of depressive disorders in patients with malignancy. METHODS A cross-sectional study was conducted in malignancy patients attending an Ear Nose Throat department using the PHQ-9 questionnaire. RESULTS Total PHQ-9 score ranged from 0 to 19; the mean score was 8.46. Major depressive disorder was seen in 4 (8%) cases, while other depressive disorder occurred in 22 (44%) cases. Mild severity of symptoms was noted in 15 (30%) of the patients. High statistical significance was noted between PHQ-9 score for MDD and other depressive disorder (p value < 0.001). CONCLUSION The profile of depressive disorders in malignancy varies; PHQ-9 can be used as a good tool for early detection.
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Affiliation(s)
- Meera Niranjan Khadilkar
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India.
| | - K Keshava Pai
- Department of Psychiatry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India
| | - Thripthi Rai
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India
| | - Vijendra Shenoy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India
| | - Deviprasad Dosemane
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India
| | - Sushmitha Kabekkodu
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Mangalore, 575001, India
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Petkov V, Ren Y, Kabekkodu S, Murphy D. Atomic pair distribution functions analysis of disordered low-Z materials. Phys Chem Chem Phys 2013; 15:8544-54. [DOI: 10.1039/c2cp43378h] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kabekkodu S. Implementation of calculated patterns quality marks in the Powder Diffraction File. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305079973] [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: 11/11/2022] Open
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Faber J, Kabekkodu S. The new PDF-4+ 2005: a relational database (RDB) with atomic structure information and on-the-fly total pattern analysis capability. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305079961] [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: 11/10/2022] Open
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