Santosh Kumar Swain

Tinnitus and its current treatment–Still an enigma in medicine

Tinnitus is a phantom auditory perception that occurs in humans. Tinnitus, which is a distressing problem affecting many people around the world, is commonly referred to as ringing in the ears. No effective drug therapy is available for this elusive disease, although much research work into mechanism and possible treatment is underway. As yet, there are no Food and Drug Administration approved drugs available and the quest for a new treatment option for tinnitus focus on important challenges in tinnitus management. A number of options have been used to treat patients with tinnitus, but outcomes have been limited. A new, curative modality will provide a turning point in the management of tinnitus. The purpose of this review article is to discuss the pathophysiology, global burden, current treatment, and prevention of tinnitus, with future prospective studies in new drug therapy for this elusive condition.

Isolated cutaneous leishmaniasis over face – A diagnostic dilemma

Abstract Cutaneous Leishmaniasis (CL) is a disease caused by an intracellular protozoa belong to the genus Leishmania, transmitted by the bite of a sandfly. It has diverse clinical presentation and may create a public health problem in endemic countries. CL is often confused with lepromatous leprosy, pimples and fungal dermatitis. This case is an isolated cutaneous variety in facial region which was mistaken and treated initially for fungal dermatitis and then for leprosy by local physicians. Smears examined from the skin lesion confirmed Leishmania amastigotes. The isolated localized CL may create confusion and its many differential diagnoses made delaying in the diagnosis.

Effect of smoking on outcome of tympanoplasty

Objective : The effect of smoking on the outcome of tympanoplasty is to be confirmed. We sought to determine the effect of smoking habit on the results of tympanoplasty over 158 patients for a period of 2years. Setting : Tertiary care hospital. Materials and Methods : The study was carried out among 158 post operative tympanoplasty, smokers were 28 and non-smoker were 130. Results : Patients without smoking habit have 93% graft uptake with 94% improved hearing after tympanoplasty. Those were with smoking habit, have 68% graft uptake with 79% improved hearing. The average hearing improvement was 20 dB among nonsmokers and 16 dB among smokers. Conclusion : This study support the poor outcome of tympanoplasty among smokers in comparison to non-smokers.

Anatomical variations of nose causing rhinogenic contact point headache – a study at a tertiary care hospital of eastern India

Resu l t s and d i scuss ion: Among 108 patient of rhinogenic contact point headache, nine distinct types of anatomical variations were seen. Different anatomical variations like septal deviation (35.18%), septal spur (26.85%), middle turbinate concha bullosa (23.14%), hypertrophied inferior turbinate (10.85%), medialized middle turbinate (0.92%), large bulla ethmoidalis (1.85%) and septal bullosa (0.92%) were found in patients with contact point headache. All were treated surgically. Treatment of each anatomical contact point was personalized for every patient.

Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis – Our experiences at a tertiary care teaching hospital of eastern India

INTRODUCTION Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. MATERIALS AND METHODS This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. RESULTS There was no significance difference according to the age (P=0.134), gender (P=0.760) and causative agents (P=0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching (P=0.0001), otorrhoea (P=0.0033), fullness (P=0.0432) and earache (P=0.0259), whereas no statistical significant on hearing loss (P=0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema (P=0.0045), tragal tenderness (P=0.0012) and congestion of tympanic membrane (P=0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. CONCLUSION Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment.

Next generation sequencing of bacteria to control Ciprofloxacin and amoxyclav antibiotic resistance in ear infections

Long standing ear infection or chronic suppurative otitis media (CSOM) is the inflammation of middle ear cleft persistent or intermittent infected ear discharge from a non-intact perforated tympanic membrane at least for 3 months of duration. Commonly ciprofloxacin and amoxyclav are used as safe and popular antibiotics for CSOM. But unfortunately the antibiotics become resistant due to the over use or miss use. To know the culture sensitivity of antibiotic pattern, it requires minimum 5 days and after getting the result, the clinician may or may not prescribe these antibiotics. But it is a time consuming method. The recent improvements in sequencing technologies, next generation sequencing (NGS) are positioned to become an essential tool in the control of antibiotic resistance, a major threat in modern healthcare. NGS has already found numerous applications in this area, ranging from the development of novel antibiotics and diagnostic tests through to antibiotic stewardship of currently available drugs via surveillance and the elucidation of the factors that allow the emergence and persistence of resistance. Numerous techniques can be developed in the value of NGS as a tool for infection control caused by bacteria as a primary diagnostic tool to detect ciprofloxacin and amoxyclav antibiotic resistance. However, appropriate data analysis platforms will need to be developed before routine NGS can be introduced on a large scale. The result will reveal the early detection of the efficacy of these antibiotics (ciprofloxacin and amoxyclav) with the clinic-microbiological profile of CSOM and to analyze the susceptibility pattern of the aerobic bacterial isolates, so that an antibiotic policy can be formulated for CSOM, for better patient management. Citation: Sahu, M.C. and Swain, S.K. Next generation sequencing of bacteria to control Ciprofloxacin and amoxyclav antibiotic resistance in ear infections [Abstract]. In: Abstracts of the NGBT conference; Oct 02-04, 2017; Bhubaneswar, Odisha, India: Can J biotech, Volume 1, Special Issue (Supplement), Page 269. https://doi.org/10.24870/cjb.2017-a253

Recurrent aphthous ulcers — Still a challenging clinical entity

Recurrent aphthous ulcer (RAU) is a clinical condition characterized by painful ulcer with different size affecting the mucosa of the oral cavity. Its etiology and pathogenesis are not clearly known and the diagnosis is based on the clinical picture. These lesions may be classified into minor, major, and herpetiformis. The aphthous ulcers in the oral cavity affect speech and feeding, leading to poor quality of life. Relevant literature was searched from PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and Scopus last 20 years using the keywords “RAU.” The RAU is a common clinical entity. The diagnosis of RAU is mainly based on clinical ground and must be differentiated from other causes of oral ulceration. The treatment is often unsatisfactory as topical application of corticosteroids and other treatment modalities minimizes the severity of the ulceration but not stop chance of recurrence.

Early detection of hearing loss with connexin 26 gene assessment

Hearing loss is the most prevalent type of sensory impairment in human beings. Hearing loss is a global problem. Genetic alteration accounts for 50% of the congenital deafness. The connexin 26 (Cx26) mutations are the most common cause behind the nonsyndromic hearing loss and it is easily identified by polymerase chain reaction. Genes responsible for hearing loss are being mapped and cloned progressively. Mutations in the gene (gap junction beta 2) encoding Cx26 have been associated with congenital hearing loss either alone or as part of a syndrome. Cx26 is a part of a large family of gap junction membrane proteins that help electrical and metabolic coupling between adjacent cells. This review article focuses on genetic analysis of nonsyndromic hearing loss, as genetic alteration in this type of deafness recently begun to be identified, epidemiology, diagnosis criteria, and emphasis in early detection.

Isolated mucosal histoid hansen's disease of nasal cavity in post elimination era

Back ground: Histoid Hansens disease is a rare form of multibacillary leprosy whereas isolated mucosal histoid is rarer with distinct clinical and histopathological features. This type of leprosy is a variant of lepromatous leprosy with a very high bacterial reserve. Case Report: A 45 year old male was diagnosed as mucosal histoid lepromatous leprosy.It is a matter of concern as we found an isolated mucosal histoid leprotic lesion inside the nasal cavity in post-global leprosy elimination era. Our case had no history of leprosy or exposure to dapsone/ multidrug therapy, with heavy bacillary index. Discussion and Conclusion: We are reporting this case to highlight the rarity of mucosal lesion of histoid leprosy, nasal cavity involvement and to create awareness and so as to avoid misdiagnosis, which will help in prompt treatment so that we can minimize the complications and deformities of the patient and also prevent its spread in the community.

An unusual presentation of extranodal Rosai-Dorfman disease threatening the airway

Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation, characterized by massive lymph node enlargement and sometimes associated with extranodal involvement. Even though it is considered as a benign disease, fatalities can occur due to its unusually large size and its location. Our case highlighting a primary extranodal site of vallecula, which is extremely rare and not reported in literature before. It presented with almost complete obstructing the oropharyngeal airway creating a life threatening situation, needed emergency tracheostomy.