A Study of Nasal Septal Deviation, External Nasal Deformities, and their Correlation with the Severity of Sino-Nasal Symptoms Using Sino Nasal Symptoms Score Questionnaire

Background/Rationale: The human nose is structurally complex and this complexity results in nasal shape and shape variations. Midline deformities such as hump nose, saddle nose, tip deformities and lateral nasal deformities such as crooked nose, deviated nose, alar depression are common forms of deformity affecting the external nose. Internal nasal valve (INV) is a key anatomical landmark of nasal cavity. Any obstructions in this region have tremendous effects on inspiratory and expiratory currents. This study aims to assess the nasal septal deviation and external nasal deformities and correlate the severity of sino nasal symptoms. Methods: This Prospective observational study will include total 50 patients with nasal septal deviation. Patients will undertake Sino Nasal Test -22 questionnaire. Investigations like Diagnostic nasal endoscopy with 30 degree nasal endoscope, X-ray PNS Water’s view and complete blood count including absolute eosinophilic count will be carried out. Data will be analysed using appropriate statistical tests. Expected Results: A significant correlation is expected between Nasal Septal Deviation, External Nasal Deformities, and Severity of Sino-nasal Symptoms. Conclusion: This study will reflect on internal nasal valve and it’s correlation with etiopathological process of upper respiratory tract. It will also guide clinicians in choosing appropriate surgical approach.

Study of Clinical Profile and Comparison of Various Dimensions of Chronic Otitis Media among the Adult and Paediatric Population from Rural Area

Background: The term Chronic Suppurative Otitis Media (CSOM) is characterized as "chronic middle ear and mastoid cavity infection, which occurs through tympanic membrane perforation with recurrent ear discharge or otorrhoea . Though there are many similarities between adult and pediatric CSOM in terms of disease progression and pathological changes, there are certain notable differences stemming from temporal bone anatomy and extent of pneumatization, the immaturity of Eustachian Tube in terms of its function and variable progression of disease. Pediatric temporal bone being more pneumatized makes the disease to spread more extensively. Childhood cholesteatoma has much greater rates of residual and recurrence disease than seen in adults. This study is aimed to compare various dimensions of CSOM among the paediatric and adult age group in rural population. Methods: This cross-sectional comparative study is scheduled from November 2020 to November 2023 in ENT Department of AVBRH, Wardha. Total 50 patients with chronic Otitis Media in the paediatric and adult age group will be enrolled. Baseline investigations will be performed for all patients and compared. Expected Results: Clinical profile and behavior of chronic otitis media in adult and paediatric population in rural areas will be outlined, emphasizing middle ear changes, grade and extent of retraction pockets and cholesteatoma respectively. Pneumatization of the temporal bone and audiological status will be reported. Conclusion: Differentiating characteristics of chronic otitis media in adult and paediatric population with specified features will be concluded.

A Review on Deviated Nasal Septum: Classification, Clinical Features and Management

The nasal septum separates the right and left part of the nasal cavity and columellar septum, membranous septum and septum proper are the parts of it. Deviation of nasal septum is a common case of nasal obstruction presented in a clinic. A lot of classifications have been developed to help ease the study of deviated nasal septum but none of them is used as a standard. Some of the classifications include the one given by Vidigal, Guyuron, Cerek, Mladina and Cottle’s. Apart from nasal obstruction other common clinical features involving deviated nasal septum are sinusitis especially in horizontal deviation type V. Pressure on lateral wall by spurs can also cause pressure headache. Due to increased air flow in the nasal cavity, dryness occurs causing epistaxis. Obstruction of nasal cavity causes mouth breathing in return either exaggerating or leading to obstructive sleep apnoea. Septal deviation also effects the choroidal thickness and choroidal blood supply. Histopathologically, lymphocytic infiltration and squamous metaplasia occurs in septal mucosa. These changes occur mostly due to change in the aerodynamic flow. There is decreased cilia movement and inferior turbinate hypertrophy. Thickness of inferior turbinate gains importance while septoplasty as, if thickened a lot, the inferior turbinate demands excision. The deviated nasal septum is associated with sinusitis, chronic suppurative otitis media and Eustachian tube dysfunction. Management involves sub mucus resection or septoplasty. Out of the two, septoplasty is preferred as it is a conservative surgery. Only symptomatic and cosmetically grossly disfigured cases require a surgical treatment while the asymptomatic cases are generally not indicated for surgery. This study tries to review the Classification, Clinical Features and Management of Deviated Nasal Septum.

Ear Wax and its Impaction: Clinical Findings and Management

Cerumen, sometimes known as "earwax," is a natural material that cleans, coats, and smooths the external auditory canal. It is the most common cause of ear canal obstruction. While cerumen blockage of the ear canal is usually painless, it can result in a variety of implications, for example, loss of hearing, tinnitus, overflowing, itching, otalgia, discharge, odour, and cough. Ear wax becomes a concern only when it causes hearing loss or other ear-related ailments. Cerumen build-up can arise for various causes, including an inability to self-clear, overproduction or underproduction of its essential components due to delayed skin movement, or mechanical difficulties such as usage of cotton buds or hearing aids. Wax can obstruct the understanding and view of the tympanic membrane and must be gone for investigative purposes or to take imprints before installing hearing support or creating earplugs. Cerumen impaction is usually innocuous; however, it might be associated with more significant symptoms. The removal of affected cerumen is typically regarded safe. However, as eardrum tear, canal laceration, and unsuccessful ear wax elimination. These dangers can be reduced by recognizing risky individuals and customising care measures to their specific needs. All common cerumen removal strategies are Cerumenolytics (ear wax emollient agents), irrigation, and manual elimination. It is also prudent not to interfere if asymptomatic individuals and tympanic membrane visualization are not required.

Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature

Introduction  Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR.

Objective  The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery.

Methods  Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters.

Results  The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24–3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm.

Conclusion  The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.

Combined Middle Cranial Fossa and Trans-Mastoid Approach for the Management of Post-Mastoidectomy CSF Otorrhoea

Cerebrospinal fluid (CSF) otorrhoea is an uncommon condition arising from defects in the tegmen and middle cranial fossa. 33 year gentleman presented with post-mastoidectomy CSF otorrhoea of 5 year duration. Imaging finding were suggestive of fracture in the tegmen region. A combined middle cranial fossa/transmastoid was used to repair the defect. Defect was identified in the tegmen plate and it was closed with pedicled pericranial graft, laterally based pedicled temporalis muscle graft reinforced by bone dust and supported with intact mucosal flap. The leak stopped completely following surgery. The patient is doing well at follow up. Repair of these defects need careful analysis of imaging findings to understand pathological anatomy, and a well planned surgical approach to achieve meticulous repair.

Effect of Tridax procumbens (Linn.) on bile duct ligation-induced liver fibrosis in rats

The present study was undertaken to clarify whether methanolic extract of Tridax procumbens prevents liver fibrosis in rat. The hepatic fibrosis was induced by 28 days of bile duct ligation in rats. The 4-week treatment with Tridex procumbens reduced the serum aspartate aminotransferase (U L⁻¹), glutamate pyruvate transaminase (U L⁻¹), alkaline phosphatase (IU L⁻¹), lactate dehydrogenase (IU L⁻¹), total bilirubin (mg dL⁻¹), direct bilirubin (mg dL⁻¹) and hydroxyproline (mg gm⁻¹) content in liver and improved the histological appearance of liver section. The results of this study led us to conclude that T. procumbens can reduce the degree of hepatocellular damage and may become antifibrotic agent for liver fibrosis.