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   2020| July-December  | Volume 4 | Issue 2  
    Online since February 19, 2021

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Cochlear implant surgery: Analysis of changes in surgical strategies for better outcomes
Naresh K Panda, Gyan Ranjan Nayak, Roshan Kumar Verma, Jaimanti Bakshi, Ramandeep Singh Virk
July-December 2020, 4(2):24-29
Objectives: Like any surgical procedure, the cochlear implant surgery is constantly in evolution. This paper highlights the various modifications in the surgical strategies that have been incorporated into the surgical procedure with regard to the changes in incision, the route of insertion of electrodes, the depth of electrode insertion, and ultimate outcome in the patients. The modifications in the surgical strategy have been based on scientific evidence. Methods: A retrospective analysis of 220 cochlear implant procedures done with the posterior tympanotomy approach has been performed. The cases performed with the alternate technique, and cochlear anomalies have been excluded. The various surgical strategies which wer evaluated included the incision, the periosteal flap, the drill hole technique, the route and depth of insertion and the surgical outcome. Results: The incorporation of mini incision drastically reduced the incidence of postoperative infection and exposure of implants (P < 0.05). The authors classified the round window membrane at posterior tympanotomy and graded them accordingly. The depth of insertion of electrodes was also evaluated prospectively. The use of modified tie down technique reduced the operative time. The vascularized temporoparietal fascia flap helped in saving 5/9 implants with exposure. Conclusions: The cochlear implant surgery is constantly evolving. This paper highlights the critical appraisal of different steps in surgical strategies that have been incorporated into the surgical procedure. This reflects the surgical audit of our cases. These surgical strategies have resulted in reducing the incidence of complications in our series and improving outcomes.
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Microscope-Assisted coblation tonsillectomy: Our experiences at a tertiary care teaching hospital of eastern India
Santosh Kumar Swain, Tushar Kanti Ghosh, Alok Das
July-December 2020, 4(2):35-38
Objective: A retrospective study was done for comparing surgical parameters such as intraoperative bleeding, duration of surgery, postoperative bleeding, postoperative pain, and hospital stay in patients undergoing coblation tonsillectomy with or without assistance of operating microscope. Materials and Methods: Data regarding intraoperative bleeding, postoperative pain, postoperative bleeding, and hospital stay were collected from the medical records of the patients undergoing with or without microscope-assisted coblation tonsillectomy during the past 5 years from December 2014 to March 2019. Results: There was no significant difference between two groups in terms of duration of surgery among coblation tonsillectomy with or without microscope. The incidence of primary hemorrhage, reactionary hemorrhage, and secondary hemorrhage was significantly reduced in case of microscope-assisted coblation tonsillectomy than direct tonsillectomy with help of headlight. Pain scores and hospital stay are significantly less in microscope assisted coblation tonsillectomy. Conclusions: Microscope-assisted coblation tonsillectomy reduces the intraoperative and postoperative hemorrhage, postoperative pain and decrease the hospital stay, so that help in an early improvement of the patient.
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Effect of poor auditory stimulation on neural activity reflected in auditory brainstem response: Comparative case study
Preeti Sahu, Monalisa Jati, Anu Nitin Nagarkar, Nitin M Nagarkar
July-December 2020, 4(2):39-44
Background: Hearing loss is often referred as an invisible disability as there are no telltale markers. Late identification and late intervention not only affects a child's speech and language development, but also it can result in poor academic performance which can ultimately lead to limited career options. Communication outcomes in hearing impaired children are influenced by a number of factors including age at onset of hearing loss, age at and adequacy of intervention, degree of hearing loss, audiometric configuration, intervention program, and family and environmental influences. Methods: A detailed comparative case history was taken followed by complete Audiological evaluative for the present paper. Purpose of the Study: The primary purpose of the current study was to determine the effects of age on auditory intervention and degree of hearing loss on auditory-based outcomes including speech perception and speech production. The study hypothesized that language outcome is not necessarily an auditory skill. The present study also highlighted the importance of correlation between different audiological tests. Research Design: This was retrospective study. Results and Conclusion: Electrophysiological test like brainstem evoked response audiometry is a reliable indicator of hearing level in an individual. A number of tests are administered to identify the hearing status of a person. A correlation between the test findings provides evidence about the anatomical and physiological substrate of the auditory system. This study provides an insight that, not only the auditory stimulation but also the nonauditory stimulation of brain is required for the development of normal communication ability in human being.
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Pediatric laryngeal papillomatosis: A review
Santosh Kumar Swain, Alok Das, Loknath Sahoo, Priyanka Debta
July-December 2020, 4(2):19-23
Laryngeal papillomatosis in pediatric age is an uncommon disease caused by the human papillomavirus which presents as warty, exophytic growths in the larynx. Child suffering from laryngeal papillomatosis frequently present with hoarseness of voice. In aggressive form laryngeal papillomatosis, it can lead to severe airway obstruction. Papillomas in the larynx often appear as exophytic nodules and this disease unpredictable in nature with spontaneous regression to aggressive persistent or recurrent disease. Fiberoptic laryngoscopy is helpful for identification of the lesions, whereas helical computed tomography is highly accurate for identification and of the disease and assessing the laryngeal airway. The definitive diagnosis is made by biopsy with histopathological examination. Surgical excision is the treatment of choice using microdebrider, CO2, or potassium titanylphosphate laser and coblation or cold steel instruments. The surgical complications may lead to vocal fold scarring, granulation tissue, webbing, and laryngeal stenosis. Coblation and Microdebrider are safe and cost effective than laser and coblation. Only maternal risk factor was primparous. Children with laryngeal papillomatosis associated with multiple surgeries in the past due to recurrence and aggressive nature of the diseases. Very young child and patients with tracheostomy need strict follow-up in case of sever diseases. In this review article, we disczuss the epidemiology, etiopathology, clinical presentations, diagnosis, and current treatment options of pediatric laryngeal papillomatosis.
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Laryngeal manifestations in pregnancy: Our experiences at a tertiary care teaching hospital of eastern India
Santosh Kumar Swain, Tapan Pattnaik, Satyabrata Acharya
July-December 2020, 4(2):30-34
Background: There are several physiological changes seen in pregnant women and among them, laryngeal changes are quite important. The laryngeal manifestations in pregnant women are mainly due to changes of the sex hormones levels and these returns to normal in postpartum period. Objective: The objective is to study the laryngeal manifestations in pregnant women. Materials and Methods: This is a prospective observational study where 54 pregnant women participated in this study for laryngeal manifestations. A questionnaire was asked to all participants for assessing the laryngeal manifestations in pregnant women. Eighty-four pregnant women in the age group of 22–35 years participated in this study. They underwent complete laryngeal and obstetric examination. Indirect laryngoscopy and laryngeal endoscopic examinations were done in all cases for the evaluation of hearing loss. Results: The mean age of the pregnant women participated in this study was 26.23 years. The most common otological manifestation was foreign body sensation in throat and it common in first trimester of the pregnancy. Dysphonia was found in 22.22% of the cases. Other manifestations were laryngopharyngeal reflux and hoarseness of voice. Conclusion: The alteration of the hormonal milieu in pregnant women can lead to several laryngeal manifestations such as foreign sensation in throat, change in voice, and irritating cough. Although there are several laryngeal manifestations are seen in pregnant women, yet these manifestations often neglected in clinical practice.
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Outcomes of hemithyroidectomy under local with general anesthesia: A tertiary center experience
Bikram Budhathoki, Shankar Shah, Bimal K Sinha, DK Baskota
July-December 2020, 4(2):45-49
Context: The prevalence of thyroid neoplasm is high in the developing countries and therefore an increasing rate of thyroid surgery. Aims: We aimed to compare the outcomes of patients undergoing hemithyroidectomy under local anesthesia (LA) with general anesthesia (GA). Settings and Design: This was a prospective, comparative study. Methods: The study was conducted for a period of 22 months in 30 patients, undergoing hemithyroidectomy under LA and GA. Patients in both the groups were assessed for duration, postoperative pain, satisfaction, postoperative complications, and cost. Statistical Analysis Used: Analysis of the data was done using the Statistical Package for the Social Sciences 16 software (IBM, New York, US). Unpaired t-test was used to test the difference of mean and Fisher's exact test was used to test the association between the two groups. P < 0.05 was taken as statistically significant. Results: The mean operative time was less in Group A (LA) than Group B (GA) (79.2 min vs. 83.6 min) (P = 0.88). The mean postoperative pain score (using the Numerical Rating Scale) was high in Group A (3.4) than Group B (2.8) (P = 0.42). There was no statistical significant difference regarding satisfaction with anesthesia. One patient in each group developed recurrent laryngeal nerve (RLN) paresis, whereas two patients in Group B developed RLN paralysis. The mean cost was less in Group A (P < 0.001). Conclusions: Hemithyroidectomy under LA can be performed safely in a selected group of patients, expecting similar operative, clinical results and patient satisfaction.
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Glomus laryngicum
Aditya Jain, Satish Nair, Deeksha Thakur, Ashish S Shah
July-December 2020, 4(2):53-56
Paragangliomas are rare benign neuroendocrine tumors that originate from the neural crest-derived cells. Paragangliomas in the head and neck are typically found in the region of the carotid body, jugular bulb, and along the 9th and 10th cranial nerves. Laryngeal paragangliomas are rare tumors and are found along the superior laryngeal nerve and recurrent laryngeal nerve. Hoarseness or dysphagia is the most common presenting symptom, and surgical excision is the treatment of choice. A 58-year-old female presented with complaints of progressive difficulty in breathing, especially on lying down with difficulty in swallowing for 1 year. Examination revealed a smooth mass lesion involving the laryngeal aspect of the epiglottis, left pharyngoepiglottic fold, and left aryepiglottic fold. Left endolarynx could not be visualized. Imaging showed a well-defined highly enhancing lesion with multiple feeders from superior thyroid, pharyngeal, and esophageal vasculature. The presumptive diagnosis was a vascular lesion or glomus tumor. The tumor was operated by lateral pharyngotomy approach with a temporary tracheostomy without preoperative embolization. Final histopathology confirmed it to be paraganglioma. The paragangliomas of the larynx are rare neuroendocrine tumors. Complete surgical excision of tumor with preservation of neurovascular structures gives an excellent prognosis.
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Imaging in malignant thyroglossal duct cyst
Ashitha Shankaralingappa, Aruna Raman Patil, Shrivalli Nandikoor, Satish Nair, Harini Raju
July-December 2020, 4(2):57-60
Thyroglossal duct cyst (TGDC) is the most common congenital neck mass, located in the midline of the neck. Majority are benign. Malignant TGDC is an extremely rare condition and is detected incidentally. We report here a case of papillary carcinoma within thyroglossal duct cyst.
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Aspergillosis of the palatine tonsil
Santosh Kumar Swain, Priyanka Debta
July-December 2020, 4(2):50-52
Aspergillosis of the palatine tonsils is extremely rare. Immunodeficiency is an important risk factor for causing aspergillosis. The diagnosis of aspergillosis of the palatine tonsil may be overlooked in immunocompetent patients as it is often seen in immunocompromised. This lesion often mimics to the malignancy or premalignant lesion. Awareness of this lesion is required among the clinician for early treatment which depends on accurate diagnosis. Isolated aspergillosis of the palatine tonsils invariably responds well to antifungal therapy with the eradication of the risk factors. The definitive diagnosis is usually done by tissue biopsy and histopathological examination. Here, we reported a case of isolated aspergillosis of the palatine tonsil without involving the other parts of the pharynx and larynx and without any generalized immune deficits in a 42-year-old male. The patient was treated by antifungal agents.
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