Satish Nair

Auditory neuropathy spectrum disorder: Its prevalence and audiological characteristics in an Indian tertiary care hospital

OBJECTIVE Auditory neuropathy spectrum disorder (ANSD) has become a well accepted clinical entity. ANSD has now become easy to recognize with advent of test battery approach for hearing loss evaluation. However, little is known about its epidemiology and aetiology, especially its prevalence and incidence in India. This study was conducted to determine the prevalence and audiological characteristics of ANSD in our tertiary care hospital at New Delhi, India. METHODS We prospectively enrolled all the paediatric cases i.e. less than 12years of age referred to our outpatient department for hearing evaluation. All the cases were evaluated using complete audiological test battery consisting of pure tone audiometry (PTA), impedance audiometry, acoustic reflexes, otoacoustic emissions (OAE), and brain stem evoked response audiometry (BERA). The instrument used was GSI Audera. BERA with both condensation and rarefaction polarity was performed in cases with absent wave V even at highest intensity levels. The criteria used for diagnosis of ANSD was normal or near normal cochlear hair cells (sensory) function (preservation of otoacoustic emissions and/or cochlear microphonics) and absent or abnormal auditory nerve function (absent or severely abnormal auditory brainstem potentials). A repeat test battery was performed after 3months on the diagnosed cases of auditory neuropathy. Based on their behavioural findings the appropriate management programme was formulated. RESULTS A total of 487 paediatric cases were referred for hearing evaluation. 183 (37.6%) cases showed absent BERA and 26(5.3%) cases fulfilled the diagnostic criteria for ANSD. Repeat examination after 3months revealed presence of OAEs in 57.6% (15/26) cases while cochlear microphonics were present in all the 26 cases. CONCLUSION The prevalence of ANSD in our study is 5.3% and in children diagnosed with severe to profound hearing loss is 14%. Presence of cochlear microphonics with absent BERA seems to be reliable criteria for diagnosing ANSD.

Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis

BackgroundThere is a growing evidence that rhinosinusitis may be associated with asthma as different manifestations of the same disorder. Several reports suggest the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis (CRS). Whether ESS has a positive effect on the clinical course of asthma still remains controversial. The aim of this study was to investigate the outcomes of ESS on asthma in patients with coexistent CRS.Materials and methodsWe performed a study to evaluate the effectiveness of ESS in 70 patients of CRS with associated asthma. The study compares changes in symptoms, medication and objective measures like pulmonary function in patients with persistent bronchial asthma and CRS before and after ESS.ResultsFollowing ESS, there was an improvement in the mean asthma symptoms (wheeze, cough and shortness of breath) and asthma medication use. The number of emergency department visits and hospital admissions also showed a reduction postsurgery. Objective analysis with pulmonary function tests revealed an improvement in the predicted scores. Three patients with extensive polyposis showed poor improvement after surgery and needed revision.ConclusionsThis study provides corroborative subjective and objective evidence that ESS is efficacious in the management of patients with CRS and asthma.

Impact of 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan on Initial Evaluation of Head and Neck Squamous Cell Carcinoma: Our Experience at a Tertiary Care Center in India

The efficacy of the whole body (WB) 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB 18 F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB 18 F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7 th edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB 18 F-FDG PET-CT scan was carried out in all these patients. The findings of WB 18 F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB 18 F-FDG PET-CT scan and also the change in staging and treatment plan after WB 18 F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn × 4 (3%), and CUPS 12 (9.1%). The majority of cases studied were of T2 and T3 stage, and changes in T staging after WB 18 F-FDG PET-CT scan were minimal and not statistically significant (P > 0.5). In the nodal staging after WB 18 F-FDG PET-CT scan, there was a statistically significant change in identification of nodal metastasis in N0 group and also identification of additional multiple/bilateral nodes (N2b and N2c). 3 (2.2%) patients had a change in M status with identification of distant metastasis in lungs (2 patients) and in the liver and lung (1 patient). Of the 131 patients, 75 (57.25%) underwent surgical management with or without adjuvant treatment (Group I) and 56 (42.74%) patients underwent nonsurgical management (Group II). There was no significant statistical difference in sensitivity and specificity of 18 F-FDG PET-CT scan in detecting cancer among the two groups. Considering all the patients in this study, WB 18 F-FDG PET-CT scan showed an overall sensitivity of 95.2% and specificity of 80%. In this study, change in TNM staging after WB 18 F-FDG PET-CT was seen in 22 (16.8%) patients and an alteration in the treatment in 21 (16.1%) patients, which were both found to be statistically significant (P < 0.5). In our study, WB 18 F-FDG PET-CT scan has shown to have an impact on initial staging of disease affecting the change in treatment protocol in a significant number of patients. The effect of this change in staging and treatment on the eventual morbidity and mortality rates is not known. In practice, the use of 18 F-FDG PET-CT scan is limited, owing to the high cost and low availability. A realistic evaluation of cost versus benefit needs to be undertaken to identify the impact of using 18 F-FDG PET-CT scan as a mode for initial evaluation of HNSCC.

Comparação do uso de implante de Silastic(r) com titânio pré-fabricado na tireoplastia tipo I

Introduction: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. Objectives: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. Methodology: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. Results: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. Conclusion: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant.INTRODUCTION Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. OBJECTIVES To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. METHODOLOGY This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. RESULTS Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. CONCLUSION TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant.

Comparison of the use of silastic with titanium prefabricated implant in type I thyroplasty

Introduction: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. Objectives: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. Methodology: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. Results: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. Conclusion: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant.INTRODUCTION Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. OBJECTIVES To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. METHODOLOGY This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. RESULTS Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. CONCLUSION TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant.

Combined Laryngocele Secondary to Localized Laryngeal Amyloidosis

Laryngocele is a benign condition due to abnormal dilatation of the laryngeal saccule. Localized amyloidosis causing laryngocele is a rare entity with few reports in the literature. We present a young male patient with a large combined laryngocele secondary to laryngeal amyloidosis.

Antrolith in the maxillary sinus: an unusual complication of endoscopic sinus surgery.

Antrolith of the paranasal sinuses are rare entity which are usually asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examinations. We report a case which presented to us with features of pansinusitis six months after endoscopic sinus surgery. Radiological examination revealed a discrete bony density in the maxillary sinus blocking the ostiomeatal complex. The bony mass was removed endoscopically from the maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. We present the imaging and review the present world literature on this rare complication of endoscopic sinus surgery.

Inverted papilloma of frontal sinus with intracranial extension.

Inverted papilloma (IP) is a benign epithelial neoplasia that accounts for 0.5–4% of all primary nasal tumours.1 It is characterised by an endophytic or inverted growth pattern of epithelium with ramifications into the underlying stroma rather than outward proliferation from the surface with an intact epithelial basement membrane.2 It affects all ages, most commonly males (M:F 3:1–5:1) in the fifth to the seventh decades of life (average age 53 years).1,3 The most frequent sites are the lateral nasal wall near the middle turbinate or ethmoid recesses and the maxillary sinuses. Although a benign lesion, IP is characterised by its relatively high recurrence rate, local aggressiveness and potential for malignant transformation. We present a rare case of IP arising from frontal sinus with extension into anterior cranial fossa treated with craniofacial resection.

Benign fibrous histiocytoma of the ethmoids in an infant

Benign fibrous histiocytoma (BFH) is a benign neoplasm of mesenchymal origin composed of histiocytes and fibroblasts.1 It is commonly found as the cutaneous form in the sun exposed skin and rarely as a non-cutaneous lesion in the head and neck. We report the clinical and pathological aspects of a rare case of BFH of the ethmoid sinus in a nine-month-old male infant patient treated at our center.

Angiomyxolipoma: Unusual swelling of oral cavity

Angiomyxolipoma (AML) is a rare variant of lipoma which presents as well circumscribed tumor characterized by proliferation of adipose tissue with a myxoid stroma and multiple thick and thin walled blood vessels. Review of literature reveals 12 cases of AML with only one case of AML of oral cavity being reported till date. We present a rare case of AML of floor of mouth with relevant review of literature.