Rohan Gupta

Cerebellar ataxia as presenting feature of hypothyroidism

Symptoms and signs of the hypothyroidism vary in relation to the magnitude and acuteness of the thyroid hormone deficiency. The usual clinical features are constipation, fatigue, cold intolerance and weight gain. Rarely it can present with neurologic problems like reversible cerebellar ataxia, dementia, peripheral neuropathy, psychosis and coma. Hypothyroidism should be suspected in all cases of ataxia, as it is easily treatable. A 40 year-old male presented with the history facial puffiness, hoarseness of voice and gait-ataxia. Investigations revealed frank primary hypothyroidism. Anti-TPO antibody was positive. Thyroxine was started and patient improved completely within eight weeks. Hypothyroidism can present with ataxia as presenting feature. Hypothyroidism should be considered in all cases of cerebellar ataxia as it is a reversible cause of ataxia.

Auditory alterations following radiotherapy in patients with head and neck malignancy: A prospective study

Aims and Objectives: The objective is to study the auditory alterations following radiotherapy (RT) in patients with head and neck (H and N) malignancy. Materials and Methods: Patients reporting to ENT OPD and those admitted, with histologically proved H and N malignancy, undergoing RT, as the treatment modality, were included in the present study, after complete ENT and general physical examination, excluding patients with previous history of ear disease, diabetes and hypertension. Results: A total 120 patients were enrolled for the present study and were examined for otological complications following RT. It was found that the patients had hearing loss, tinnitus, ear fullness and serous otitis media. Hearing loss was mainly sensorineural and was mostly seen in carcinoma of the oral cavity, oropharynx, and nasopharynx. The patients with carcinoma of esophagus, thyroid, and occult primary did not show any significant change in hearing. Conclusion: As radiation field descends down from nasopharynx to esophagus, the effect on otological structures decreases.

Interlay Type I tympanoplasty in large central perforations: Analysis of 500 cases

Aims and Objectives: To study the outcomes of interlay tympanoplasty (Type I) in patients with large central perforations (inactive mucosal chronic otitis media [COM]) in terms of graft uptake and hearing improvement. Materials and Methods: The present study is an analysis of database of 500 patients of inactive mucosal COM with large central perforation, who had undergone Type I interlay tympanoplasty at Jain ENT Hospital, Jaipur, during the past 5 years. Results: The graft uptake rate in the present study was found to be 96.6%, and 95.4% of the patients reported an improvement in terms of hearing with the mean air-bone gap improving from 26.08 to 10.12 dB. Conclusion: Tympanoplasty done by interlay technique has excellent results both in terms of graft uptake and hearing improvement, with minimal complications.

Auditory alterations following chemoradiotherapy: A comparative study between cisplatin and paclitaxel

Aim: To study the auditory effects of chemoradiotherapy with cisplatin and paclitaxel. Materials and Methods: Eighty patients with head and neck cancer undergoing chemoradiotherapy with cisplatin or paclitaxel were enrolled for the present study and monitored for any auditory alterations. Results: Forty-eight patients underwent chemotherapy with cisplatinum while 32 patients with paclitaxel. Hearing loss was observed along with tinnitus, vertigo, and nausea and vomiting. Conclusion: Taxanes-based chemoradiotherapy cause less auditory alterations than cisplatin-based chemoradiotherapy.

Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma

Aim: To evaluate the role of high-resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media (COM). Materials and Methods: Totally, 47 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra-operative findings were considered as the gold standard and were compared and correlated with the radiological findings, to calculate the sensitivity, specificity, positive and negative predictive value of HRCT temporal bone. Results: According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters. Conclusion: The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.

Overlay versus underlay myringoplasty: A comparative study

Aims and Objectives: The objective of this study is to compare the outcome of overlay versus underlay myringoplasty procedure in the management of chronic inactive mucosal otitis media in terms of graft uptake, hearing improvement and complications. Materials and Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, S.M.G.S Hospital, Government Medical College, Jammu from June 1, 2012 to September 31, 2013 and clinical records of 77 patients who underwent myringoplasty by either overlay or underlay technique in this period were analyzed. A total of 72 patients with dry central tympanic membrane perforations of various sizes were included in this study. These patients were divided into two groups. In Group A, 37 patients were included in which tympanic membrane was repaired by using overlay technique of myringoplasty, whereas Group B comprised of 35 patients who underwent underlay myringoplasty. The results of two techniques were compared in terms of graft success rate that is, full uptake or failure to take up, medialization or lateralization of graft within 6 months of operation and improvement in hearing at the end of 6 months of follow-up. Results: In terms of graft uptake and postoperative AB gap improvement, Group B (underlay group) was slightly better with 91.43% uptake rate and mean postoperative AB gap of 11.11 dB than Group A (overlay group), which had 89.18% uptake rate and 11.72 dB as mean postoperative AB gap, though the difference was not statistically significant. There was only 1 case of graft medialization in Group B, while 3 cases had lateralization of graft in Group A. Conclusion: Both techniques of myringoplasty achieve satisfactory results, with the underlay technique being slightly better than the overlay technique. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation.