Pattern and Perception of Impact of Wearing Face Masks on Communication Among Health Care Workers During COVID-19 pandemic: An Observational Study

To assess the impact of wearing masks (KN95, surgical, cloth mask) due to COVID-19 pandemic on interpersonal communication among health care workers and with patients. The present observational study was conducted in tertiary care centre and also included participants from various other health care facilities from all over India over a period of one year from March 2022 to March 2023. 203 health care workers consented to participate in the study. The study was done as an online survey using the questionnaire which was adapted into a Google form consisting of a 15 closed set questions. Participants rated the question using a binary forced choice as either YES or NO. The mean age of participants consenting to the study was 30.9 ± 6.3 SD years,with male predominance (%). Among the choice of use of face mask, 76.35% used surgical mask, 14.77% used KN95 and 8.86% used cloth masks. 15 questions were divided in 5 categories; analysis showed that majority of questions had an affirmative "yes" response. This results of this study indicated that the sudden change in the existing communication situation due to use of face masks in the clinical setup affected interpersonal communication among healthcare workers and with patients, which may also have a bearing on both patient and clinician well being and could have a significant economic impact on health care systems globally. These results provide information about the clinical strain introduced from use of face masks in healthcare settings. Overall, results showed that in healthcare settings, there is increased cognitive load and listening effort for patients and health care providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss.

Assessment of Effects of Chronic Mobile Phone Usage on Auditory Functions: A Study at a Tertiary Care Teaching Hospital in Northern India

Genuine concerns are being increased regarding potential health risks associated with the radiation exposure while using mobile devices. To study the effects of mobile phone usage on auditory functions. The detailed history of the patient was obtained with special emphasis on total cumulative usage [in years], average daily use [in minutes]. According to the years of exposure, subjects were divided into Group A (< 5 years of exposure) and Group B (> 5 years of exposure) and according to the average daily usage of mobile phones, subjects were divided into Group 1 (< 60 min daily usage) and Group 2 (> 60 min of daily usage). After that systemic examination was done. Audiological testing included pure tone audiometry (PTA) with extended high frequencies (0.250-12 kHz), Otoacoustic emissions (OAE) and Auditory Brainstem response (ABR) testing and middle latency response (MLR) were performed. Out of 100 subjects, maximum subjects (38%) in the present study were in the age group of 21-30 years with male: female ratio of 1.6:1. The main associated complaints in the subjects at the time of enrolment in the study included ear warmth (34%) followed by aural fullness (20%) and tinnitus (17%). In Group A, mild SNHL was seen in 3 (11.54%) subjects in whom 2 had > 60 min average daily use and 1 had < 60 min daily use. In Group B 19 (25.68%) subjects had mild SNHL out of which 6 were in Group 2 and 13 were in Group 1. In group B 2 (2.7%) subjects had moderate SNHL. Increase in latencies of Na and Pa were noted with prolonged and frequent exposure to mobile phones in MLR. It is advised to limit the usage of mobile phones so as to reduce the damage caused by EMRs to the auditory system.

Prognostic Significance of Pre-Treatment Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Head and Neck Malignancies

Introduction

Carcinoma is the second most common cause of death worldwide. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are essential markers of inflammation and tumorigenesis in various cancers including head and neck cancers. Pretreatment platelet- lymphocytic ratio can be used as an independent predictor of mortality whereas neutrophil- lymphocytic ratio is an independent predictor of recurrence. The main aim of this study is to compare the pre-treatment neutrophil lymphocyte ratio and platelet-lymphocyte ratio in the patients of head and neck malignancies with those of the control group.

Material and Method

100 patients with histologically diagnosed cases of head and neck malignancies. Age and sex matched healthy subjects attending Otorhinolaryngology out-patient department for any other complaints (100 control subjects). Complete blood count had been done to calculate absolute neutrophil count and absolute lymphocyte count.

Results

The mean age of the subjects in the study group was 55.73 ± 11.56 years. In control group, the mean age group was 54.11 ± 10.46 years. NLR and PLR significantly increased in cases than controls. NLR associated with T stage, histological type and histological grade but not with site and nodal involvement. PLR associated with T stage, metastasis but not with the histological grade, histological type, site and nodal involvement.

Conclusion

From this study, we conclude that pre-treatment NLR and PLR were closely associated both with the size of primary tumor and also with the stage of malignant disease in patients of head and neck malignancies.

Role of Voice Handicap Index in Evaluation of Patients with Moderate to Severe Bilateral Sensorineural Hearing Loss

Background

Our ability to hear and speak enables us to communicate with others, forming an integral part of our emotional and social well-being. Vocal problems in hearing-impaired patients have yet to be assessed in terms of subjective level of disability they cause. Present study aims to assess the different Voice Handicap Index (VHI) scores among patients with moderate to severe sensorineural hearing loss and compare them to those with normal hearing.

Materials and Methods

In this prospective case control study(n = 150), study group A (n = 100) consisted of subjects with bilateral moderate to profound hearing loss on Pure tone audiometry and control group B (n = 50) with normal hearing. Both groups were asked to fill out VHI form after a normal videostroboscopic assessment.

Results

Mean VHI score in group A was 57.5 ± 12.48 and 6.0 ± 3.24 in group B, difference being statistically significant. A strong positive correlation was found between severity of hearing loss and VHI total score. The difference between both groups was also statistically significant for each of the three subscales of VHI.

Conclusion

We infer that subjects with moderate and higher bilateral sensorineural hearing loss hearing have statistically significant higher VHI scores as compared to those with normal hearing. It was observed that perception of voice handicap increased with the severity of hearing loss. These findings emphasize the need for multilateral assessment and treatment of voice disorders in subjects with hearing loss.

Comparison of Outcomes of Early Versus Late Tracheostomy in the Treatment of Mechanically Ventilated Critically ill Patients

Comparative evaluation of early and late tracheostomy outcomes in mechanically ventilated patients. The present retrospective study was conducted in Government medical college Jammu from April 2021 to November 2022 on 111 tracheotomised patient in intensive care unit. All tracheostomies with in 10 days of intubation were grouped as early tracheostomy (ET) group and all those done after 10 days were grouped as LATE TRACHEOSTOMY (LT) group. APACHE II score at the time of intensive care unit admission of all included tracheotomised patients was noted. Data regarding mortality, duration of mechanical ventilation and length of stay in intensive care unit (ICU) was studied. Mean age of presentation was 41.5 ± 15.7 yrs, with male preponderance. Out of 111 patients, 57 patients underwent early tracheostomy and 54 underwent late TRACHEOSTOMY. In APACHE II, < 25 category-short term mortality was 4 in ET and 5 in LT; long term mortality in ET was 4 and 10 in LT; average days of mechanical ventilation were 11.2 in ET and 3 in LT; average stay in ICU was 18 days in ET and 61 days in LT. in APACHE II > 25-short term mortality was 4 in ET and 5 in LT; long term mortality in ET was 3 and 9 in LT. Average days of mechanical ventilation were 10.8 in ET and 57 in LT; average stay in ICU was 24 days in ET and 79 days in LT. Early tracheostomy is superior to late Tracheostomy in terms of mortality, number of days of mechanical ventilation and the duration of intensive care unit stay.

Surgical Outcomes of Endoscopic Versus Conventional Septoplasty

The most common cause of nasal obstruction is a deviated nasal septum. It causes breathing difficulties and may eventually also cause sinusitis, epistaxis, sleep disturbances and snoring. The traditional surgeries of the nasal septum improve the nasal airway but do not fulfil the essential criteria in most instances. Endoscopic septoplasty is a fast-developing concept and gaining popularity as it provides a direct targeted approach to the septal anatomic deformity allowing a minimally invasive procedure under excellent visualization. The aim of this study is to compare the post-operative morbidity among conventional and endoscopic septoplasty. The present prospective study was conducted on 50 patients having deviated nasal septum. Patients were randomly divided into two groups of 25 each. Out of 50 patients, in 25 patients (Group A) Conventional septoplasty was done, whereas in other 25 patients (Group B) endoscopic septoplasty was done. The patients were followed up post-operatively at 2 weeks, 4 weeks and 8 weeks. Study Design: comparative study. The mean of operating time (min) in Group A was 60.47 ± 8.16 which was significantly higher as compared to Group B (39.7 ± 6.73). (p value < .0001). The Mean of blood loss (mL) was significantly higher in Group A (88.67 ± 8.77) as compared to Group B. (54.6 ± 7.18). (p value < .0001). Post-operative NOSE score at one month was 7.33 ± 1.5 in group A which was significantly higher as compared to Group B (5 ± 1.41). (p value = 0.0007) whereas post-operative NOSE score at 3 months in Group A was 6.53 ± 1.25 which was significantly higher as compared to Group B (4.4 ± 1.78). Proportion of post-operative complications was comparable in Group A and Group B (No complication 80% vs. 92% respectively). According to the present study, both the conventional and endoscopic septoplasty procedures were effective in relieving nasal obstruction in the patients. Endoscopic septoplasty showed significantly better result than conventional septoplasty in terms of time taken for surgery, blood loss during the surgery, post-operative complications and in terms of quality of life as assessed by NOSE Score.

Maxillary Sinus Angiofibroma: A Rare Entity

Juvenile Nasopharyngeal Angiofibroma (JNA) is an unusual benign, although destructive fibrovascular tumor of the nasopharynx which rarely present itself at other sites. Maxilla is the most frequent extranasopharyngeal site of origin. We report a case of Extranasopharyngeal Angiofibroma (ENA) arising from maxillary sinus in an adult patient which was excised into successfully.

The Variations in Deviation of Nasal Septum and their Impact on Maxillary Sinus Volume and Occurrence of Sinusitis

To study the effect of variations in deviation of the nasal septum and their impact on maxillary sinus volume and occurrence of sinusitis. This prospective observational study was conducted in the department of ENT, Head &Neck surgery GMC Jammu from August 2021 to November 2022. 130 patients (90 males, 40 females), with age range of 18-47 years with DNS were included in the study. Grade of DNS was classified according to Mladina's classification and volume of maxillary sinus was calculated using geometric formula by performing 256 slice CT Scan. In our study mean age of the males was 32.8 ± 6.99 years and females was 33.7 ± 7.26 years with Male: Female ratio of 9:4.Patients with grade 1 DNS had mean maxillary sinus volume of 9.9 ± 1.97 cu mm while patients with grade 7 DNS had mean maxillary sinus volume of 3.8 ± 1.47 cu mm. Thus, with the increasing grade of DNS, the OMC blockage increased towards the side of DNS and so the occurrence of maxillary sinusitis. The study showed that with high grade DNS, the maxillary sinus volume decreases on the side of septum deviation and there is association of blocked OMC with increasing grade of DNS. The incidence of maxillary sinusitis findings on the side of septum deviation was significantly increased.

Relationship Between Lipid Profile and Sensorineural Hearing Loss: An Institution Based Study

Sensorineural hearing loss is the most frequent problem worldwide and is the most neglected condition. Thus, it is essential to understand the etiology and pathophysiology of SNHL. The main objective of the study is to find whether serum lipid parameters have any correlation with SNHL. 68 patients within the age group of 20-60 years with clinically diagnosed sensorineural hearing loss were included in this study. Informed written consent, otoscopy, pure tone audiometry were done on all patients. The subjects were subjected to Serum lipid profile. The mean age of subjects in this study was 53.25 ± 13.78 years and male to female ratio was found to be 1.125:1. The serum total cholesterol and serum triglyceride also showed significant relationship with the degree of hearing loss (p value < 0.001). With an increase in the serum LDL there was increase in the severity of hearing loss which was statistically significant (p value < 0.001) where as serum HDL level showed statistically insignificant and negative correlation with severity of hearing loss. Serum lipid profile can be used as important biomarker for assessing the severity of hearing loss. Subjects with deranged lipid parameters had higher degress of hearing impairement.

Elective Tracheostomy During Covid-19 Pandemic- A Tertiary Care Centre Experience

Aims and Objectives

: The aim of our study was to present an experience of elective tracheostomy in COVID-19 patients at our institute.

Materials and methods

The present prospective study was conducted, after approval by Institutional Ethics Committee, in the Department of ENT, SMGS Hospital, GMC Jammu from May 2020 to March 2021 over 60 patients having need for prolonged mechanical ventilation and having tested positive for COVID-19 with nasopharyngeal swab on rtPCR assay testing. Detailed information regarding following aspects was gathered :Age, Gender, Comorbidities (Diabetes, Cardiovascular disease, Pulmonary disease, Malignancy), time of endotracheal intubation to tracheostomy, time to wean sedation after tracheostomy, time to wean mechanical ventilation after tracheostomy, surgical complications, mortality, any health care worker in operating team getting infected by SARS-CoV-2. All 60 patients underwent Elective Open Tracheostomy Bed-side in the ICU section of our institute.

Results

The mean age of presentation was 55.9 ± 2.34 years, with male preponderance. The most common indication for tracheostomy was ARDS (Acute Respiratory Distress Syndrome) (56.6%). Out of 60 patients, co-morbidities were present in 44 patients (73.3%). The mean time between endotracheal intubation and tracheostomy was 12.2 ± 4.9 days. The mean time to wean mechanical ventilation after tracheostomy was 10.4 ± 2.31 days. The mean time to wean sedation was 2.2 ± 0.83 days. There were no deaths during the procedure. Out of 60 patients, 5 patients (8.3%) died due to complications of COVID-19.

Conclusion

Our study provides important clinical data (such as timing of tracheostomy, pre-operative evaluation of patients, recommendations during procedure, outcomes of tracheostomy and postoperative care) on this threatening issue of tracheostomy in COVID-19 patients and might be of immense help to various Otorhinolaryngologists who are dealing with the same situation.

Tissue Transfer After Tongue Resection: Micro-Vascular Reconstruction Using Radial Artery Free Flap versus Reconstruction by Split Thickness Skin Graft in T2 Lesions of Tongue Carcinoma

To compare postoperative complications, functional rehabilitation, surgical outcomes of the radial artery forearm free flap (RAFFF) and split thickness skin graft (STSG) reconstruction of postsurgical defect in T2 lesions of cancer oral cavity. Observational Prospective comparative study. Academic tertiary referral centre. In our study of forty four patients, after tumour resection, half underwent reconstruction using RAFFF (Group I) and another half by STSG (Group II). All of the patients were followed postoperatively to determine and compare their functional outcomes related to donor site and recipient site complications, speech, deglutition and mouth opening. The speech intelligibility and deglutition were each assessed using Articulation Handicap Index and Vedio-fluoroscopy using the Functional oral intake scale. Operative time for STSG reconstruction was shorter at 2.2 ± 0.97 SD hours compared to 5.9 ± 1.24 SD hours for RAFFF reconstruction. Hospital stay was 8.3 ± 1.19 SD days for STSG patients and 12.6 ± 1.7 SD days for RAFFF patients. The functional outcomes of speech quality and swallowing were near comparable in both groups but the donor site complications were significant in the RAFFF group. Operative time, hospital stay and donor site complications are both significantly reduced with the STSG as opposed to RAFF. Functional and oncologic results of both methods are near comparable. To conclude, STSG can be used for reconstruction of the post-surgical defects in T2 lesions of the tongue.

Anterior inferior cerebellar artery loop and tinnitus—is there any association between them?

Background

Where there is no identifiable cause of otologic symptoms like hearing loss and tinnitus, it is believed that etiology could possibly involve a vascular loop in AICA compressing the vestibulo-cochlear nerve within the internal auditory canal. In this study, we aim to evaluate whether there is any association of AICA vascular loops with unexplained tinnitus.

Methods

The present prospective study was conducted in the Department of ENT, SMGS Hospital, GMC Jammu, from October 2020 to March 2022 on 131 subjects with unexplained tinnitus. All subjects were subjected to contrast enhanced MRI brain (3D fast spin echo T2W1 with drive equilibrium pulse) for evaluation of AICA using Chavda classification—type 1 (lying in CP angle, but not entering IAC), type 2 (entering IAC but extending < 50% of length of IAC), and type 3 (extending > 50% of length of IAC).

Results

Out of 131 unexplained tinnitus cases, 76 patients (58%) had AICA loop on MRI. Out of 16 patients with right sided tinnitus, 11 patients had AICA on same side, while 5 patients had AICA on the opposite (left) side. Out of 26 patients with left-sided tinnitus, 12 patients had AICA on same side, while 14 patients had AICA on the opposite (right) side, these findings being statistically insignificant (p = 0.153).

Conclusion

From our study, we can conclude that the presence of AICA vascular loop either on CP angle or within IAC in tinnitus patients is an incidental finding and has no role in its etiology.

A Clinical Study to Evaluate the Role of Vitamin D3 in Allergic Rhinitis

Allergic rhinitis is a common and chronic immunoglobulin E-mediated inflammation of nasal mucosa induced after allergen exposure. Allergic rhinitis is a global health problem that causes major illness and affects patient's social life, sleep, school and work performance. Various studies have implicated the association between low serum vitamin D levels and allergic diseases. Active form of Vitamin D3 has been shown to have immunoregulatory effect on both innate and adaptive immunity, which can significantly affect the outcome of allergic responses in allergic rhinitis. The study aims to evaluate effectiveness of Oral Vitamin D3 supplementation as an adjunct to standard therapy, in the management of allergic rhinitis. The present study is a prospective study in which 80 subjects were recruited and were randomly divided into two groups. The study group received oral vitamin D3 (60,000 IU) along with intranasal steroid spray while control group received only intranasal steroid spray for 4 weeks. The response in both the groups was compared by evaluating total nasal symptom score (TNSS). Subjects of allergic rhinitis showed deficiency in vitamin D indicated by mean serum vitamin D levels of 15 ± 2.42 ng/ml in the study group and 14.72 ± 2.64 ng/ml in the control group. The pre treatment mean TNSS score was 10.45 ± 3.1 in the study group and 11.43 ± 2.35 in the control group. The post treatment mean TNSS score was 2.1 ± 0.21 in the study group and 3.85 ± 0.76 in the control group. A significant reduction in symptoms score was observed after 4 weeks of oral vitamin D3 supplementation. The difference between two groups was found to be statistically significant (p value < 0.05).

Intratympanic Dexamethasone in Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss can be a frightening experience for the sufferer and needs immediate treatment. Systemic steroid therapy has been the mainstay of treatment of this condition but concerns about their side effects has led to their use by intratympanic injection. We studied the results of intratympanic dexamethasone (IT-Dexa) both as a primary therapy and as salvage treatment after failure of oral steroids. A total of 39 patients of SSNHL were studied prospectively. Of these 23 were given oral steroids. Ten of these showed no response and were treated with IT-Dexa 4 mg/ml twice a week for two weeks. In addition, 16 patients who reported later than two weeks or had concomitant medical disorders like diabetes and/or hypertension were treated with IT-Dexa. While oral steroids showed hearing improvement (≥ 10 dB) in 56.5% patients, the recovery rate was 62.5% and 80% in those treated primarily with IT-Dexa and as salvage therapy respectively. There was a negative correlation of delay in institution of treatment with hearing recovery. Conclusion: intratympanic dexamethasone is a safe and effective treatment and should be offered to patients as a primary treatment modality and also as salvage therapy after failure of oral steroids. For best results the treatment should be started at the earliest.

Endoscopic Adenoidectomy Replacing the Outdated Curette Adenoidectomy: Comparison of the Two Methods at a Tertiary Care Centre

To compare intraoperative and postoperative parameters of the two techniques of adenoidectomy, endoscope and microdebrider powered adenoidectomy and conventional adenoidectomy. Study Design Prospective study. Setting: Academic tertiary referral centre. In our study, cases of adenoid hypertrophy were randomly selected from the outpatient department of department of ORL & HNS. Out of these patients, 30 underwent Endoscopic adenoidectomy (EA) (Group A) and 30 underwent Conventional adenoidectomy (CA) (Group B). All of the patients were assessed pre-operatively, intra-operatively and post-operatively to compare the various parameters. The most common complaint in both the groups was mouth breathing with snoring. Intra-operative bleeding was 29.15 ml in group EA and 15.2 ml in group CA. Operative time for CA was shorter at 21.8 min as compared to 32.1 min for group EA. Residual adenoids and injury to adjacent structures were more common in group CA. Hospital stay was 3.2 days for EA patients and 3.43 days for CA patients. Resolution of symptoms was near comparable in both groups. Operative time and intra-operative bleeding are both significantly reduced with the CA as opposed to EA. However, injury to adjacent structures and residual adenoids occur significantly less in group EA. After weighing the risks and benefits, we can conclude that EA is comparatively better than CA.

Relation of Superior Laryngeal Nerve and Superior Thyroid Artery with Superior Pole of Thyroid During Thyroid Surgery

The purpose of this study was to evaluate relation between superior thyroid vessels, external branch of superior laryngeal nerve and superior pole of thyroid based on Cernea classification in Jammu population. The present study was conducted on 50 patients in Department of ENT & Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu during a time period of January 2018 to March 2020. Patients undergoing selective thyroid surgeries for various pathologies were included in the study. Patients with preoperative vocal cord palsy and patients with malignant thyroid neoplasms were excluded from the study. All patients were operated under general anaesthesia, with supine neck extended position. The bifurcation and the branches of STA were meticulously dissected preserving all the branches and any anastomoses if present. Once visualization of the nerve was attained, various measurements were taken to assess Cernea classification type. Depending on extent of lesion appropriate surgical procedure was done so as remove all the diseased tissue. Out of total 62 lobes, Cernea's Type 1 pattern was seen in 33 (53.2%) of patients, Cernea's Type 2a was seen in 11 patients (17.7%) and Cernea's Type 2b was seen in 14 patients (22.5%). No specific pattern was seen in 4 (6.4%) of patients. Cernea classification system is a simple and reliable guide to identify and preserve the nerve.

A Prospective Study of Audiological Manifestations in Patients of Allergic Rhinitis

Allergic rhinitis is a type-I hypersensitivity reaction of the nasal mucosa, primarily mediated by immunoglobulin E (IgE) with complex etiological factors.Allergic rhinitis may involve the inner ear. The scientific basis for this is poorly understood. However, the inner ear has been found to demonstrate both cellular and humoral immunity, and the seat of immuno-activity appears to reside in the endolymphatic sac and duct. To assess the audiological profile of patients with allergic rhinitis. 100 Study group patients and 50 control group subjects underwent detailed audiological assessment. Present study revealed high frequency sensorineural hearing loss with prolongation of Wave I and shortened wave I-III and Wave I-V interpeak latencies on ABR and abnormal DPOAE findings, compared with controls which indicate inner ear involvement (cochlear pathology). Individuals with allergic rhinitis are more prone to hearing abnormalities which can be detected even before any symptoms of hearing impairment are present. However, the exact pathophysiology of inner ear damage in patients of airway allergy is poorly understood and therefore, additional studies in this area are required with a larger sample population to assess the benefits of hearing assessment in patients of allergic rhinitis for early detection of hearing loss.

Otological Assessment in Head Injury Patients: A Prospective Study and Review of Literature

Head injuries constitute a tragic problem invariably in under-developed, developed and developing countries. The concomitant otological injuries often go unnoticed. The purpose of this study was to assess the various otological manifestations following head injuries. Prospective study with review of literature using PubMed database was done. All the patients were evaluated for their presenting symptoms and signs. Audiological investigations including PTA (Pure tone audiometry), OAE (Otoacoustic emission), Impedance-Audiometry and BERA were done. HRCT temporal bone was advised in cases of suspicion. Relevant literature was reviewed to calculate the pooled prevalence rates. Random-effects model to synthesize overall effects was used. Heterogeneity was evaluated with the I² statistic. Of 53 patients enrolled in the study, RTA was the most common mode of injury. The audiometric findings showed SNHL, CHL and mixed HL in 34, 20 and 18% of patients respectively. HRCT showed Longitudinal fracture (n = 17; 53.12%); isolated mastoid bone fracture (n = 9; 28.12%), transverse (n = 3; 9.37%) and isolated EAC fracture in (n = 3; 9.37%) patients. The pooled prevalence (n = 1106 patients) of SNHL, CHL, Mixed HL and Normal hearing were-35% (95%CI, 18-55%; I² = 95.20%; P < 0.00), 24% (95%CI, 16-33%; I² = 80.01%; P < 0.00), 15%(95%CI, 9-23%; I² = 79.64%; P < 0.00) and 30% (95%CI, 3-66%; I² = 98.71%; P < 0.00) respectively. The pooled prevalence (n = 4191 patients) of longitudinal, Transverse, mixed and other fractures were-44% (95%CI, 3-66%;I² = 99.48%; P < 0.00), 9% (95% CI, 4-16%; I² = 95.95%; P < 0.00), 4% (95%CI, 1-8%; I² = 94.13%; P < 0.00) and 1% (95%CI, 0-4%; I² = 90.37%; P < 0.00) respectively. In patients with head injury coordination between the trauma-surgeon, neurosurgeon and otologist is must to improve the long-term outcomes.

Incidence of Olfactory and Gustatory Dysfunctions in the Early Stages of COVID-19: An Objective Evaluation

Introduction Coronavirus disease 2019 (COVID-19) is a dangerous infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has various clinical presentations. Numerable cases with non-specific olfactory and gustatory dysfunctions in COVID-19 have been reported from all over the globe. This is important as awareness will let people to self-isolate and help in limiting disease spread.

Objective To objectively evaluate the frequency of olfactory and gustatory dysfunction, which may occur independently or with other symptoms, in laboratory confirmed COVID-19 patients at an early stage of the disease.

Methods Objective evaluation of olfactory and gustatory function of 322 COVID-19 patients treated at our hospital, (SMGS, Government Medical College, Jammu), from August 2020 until November 2020.

Results Our study population included 127 (39.4%) males and 195 (60.6%) females. Two hundred and twenty-six (70.2%) COVID-19 patients experienced olfactory and gustatory disorders. One hundred and sixty-five (51.2%) cases experienced both olfactory and gustatory disorders. Isolated olfactory dysfunction was reported in 34 (10.6%) patients, while 27 (8.4%) patients experienced only gustatory dysfunction.

Conclusion The olfactory and gustatory dysfunctions, without any nasal obstruction or rhinorrhea, are significant symptoms in the clinical presentation of early COVID-19 patients. This presentation can be recognized at the earliest one, and it can reduce the high communicability of the COVID-19 disease.

Halitosis: Its Aetiology and Psychosocial Impact- A Hospital Based Study

Introduction Halitosis means bad or unpleasant odour from oral cavity. It causes embarrassment to the patients and affects their social life and communication. This study aims to find the causes of halitosis and to assess its psychosocial impact. Materials and Methods A prospective study was conducted in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care hospital. It included 165 patients, presenting to the ENT OPD with chief complains of oral malodour for at least 3 months. The patients in the age above 15 years and below 75 years, irrespective of gender, were included in the study. Results The age of the patients ranged from 15 to 75 years with a mean age of 52.24 ± 15.67 with male: female ratio of 7:10. The most common cause of halitosis in the present study included chronic rhinosinusitis (38.7%), gingivitis/periodontitis (19.39%), tonsillitis (4.84%), laryngopharyngeal reflux (2%), deep neck space infections (1.2%). In 23.56%, the halitosis was a symptom of an underlying malignancy. Conclusion Halitosis from an extra oral origin can be the sign of an underlying systemic disease or malignancy. The consultation should be done with the periodontist, ENT specialist and a physician.

Impact of Site, Size and Duration of Tympanic Membrane Perforation on Hearing Loss and Postsurgical Outcome

This paper aims to assess correlation of site, size and duration of tympanic membrane perforation with hearing loss using pure tone audiogram and surgical outcome in terms of above parameters. The present study was conducted on 100 patients in Department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15-60 years who presented with tympanic membrane (pars tensa) perforation were included in the study. According to the size of perforation, mean pure tone threshold in group I was 20.87 ± 3.86 dB, in group II was 26.45 ± 6.08 dB and in group III was 32.6 ± 5.56 dB. The difference in hearing threshold between all the three groups was significant statistically. In terms of site, group E had maximum hearing threshold (34.67 ± 4.20 dB), followed by group B (32.71 ± 5.88 dB). Group A had the lowest hearing threshold of 24.99 ± 6.21 dB. The difference between hearing thresholds of group B perforations and group A perforations was statistically significant (p < 0.05). However, the difference between group E and group B was insignificant. This study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss. The bigger the perforation, the greater the hearing loss. The central perforations were associated with more hearing loss than posterior perforations, thus refuting the hypothesis that site and size of a tympanic membrane perforation does not affect the degree of conductive hearing loss. This study did not show any correlation between duration of disease and degree of hearing loss. Surgical and audiometric results obtained in this study can be accepted as satisfactory and as expected by the literature.

Olfactory and Gustatory Alterations in Covid-19 Patients: A Tertiary Care Covid-19 Centre Inpatient Experience

Corona virus disease 2019 (COVID-19) has emerged as a deadly pandemic throughout the world. Many case series from all over the globe and in India are detecting a very high frequency of chemo sensitive disorders in COVID-19. There is increasing evidence that olfactory and gustatory dysfunction can be present in COVID-19 patients. Olfactory and gustatory function was subjectively tested in 300 COVID-19 patients admitted at our hospital, Government Medical College, Jammu first through telephonic interviews followed by online questionnaire. Among our test population, 159 patients (53%) reported olfactory and gustatory alterations within 5 days of testing positive for COVID-19. 52% of those complaining olfactory dysfunction developed it before testing positive while 45% of those having gustatory dysfunction reported the same before testing positive for the disease. Olfactory and gustatory dysfunctions represent common clinical findings in COVID-19 patients. Otorhinolaryngologists and head-neck surgeons must by now keep this diagnostic option in mind when evaluating cases of non-specific anosmia and ageusia that arose suddenly and are not associated with rhinitis/influenza symptoms.

Neoadjuvant versus concurrent chemotherapy in the management of carcinoma nasopharynx

e17053

Background: Chemotherapy is added to radiotherapy in the treatment of nasopharyngeal carcinoma with advanced locoregional disease to enhance therapeutic gain. Thirty percent patients with locally advanced nasopharyngeal carcinoma (LA-NPC) still die of distant metastases despite concurrent chemoradiation being the standard of care. In this retrospective study we performed the pooled analysis of these patients to assess the impact of neoadjuvant chemotherapy versus the concurrent chemoradiation approach. Methods: Between January 2000 and December 2007, 45 patients of stage IIB- IVB nasopharyngeal were treated with 3 cycles of induction chemotherapy with cisplatin and 5FU (n = 23) followed by conventional radical radiotherapy, or concurrent chemoradiation with weekly cisplatin (n = 22). Results: Total numbers of patients eligible for analyses were 45. Median age of the patients was 52 years (range 19–76 years). Median follow up was 17 months (range 6–60 months). At the time of last follow up, 13 patients (out of 23, i.e. 56.53%) were alive and disease free in the neoadjuvant group and 13 patients (out of 22, i.e. 59.1%) were alive and disease free in the concurrent chemoradiation group. The 2-year failure free survival in the concurrent chemoradiation arm was 63% versus 35% in the neoadjuvant arm (p = 0.197). Survival analyses adjusted for the gender male revealed 2-year failure free survival as 81% in the concurrent chemoradiation versus 44% in the neoadjuvant chemotherapy group among male patients (p = 0.0143). On multivariate analysis age and stage were the two significant predictive factors for failure free survival. Conclusions: The neoadjuvant chemotherapy seems to be at least as effective as concurrent chemoradiation in this small cohort of patients.

No significant financial relationships to disclose.

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