Shelly Chadha

A Study of Voice Changes in Various Phases of Menstrual Cycle and in Postmenopausal Women

Larynx is responsible for the generation of voice and subsequently impacts on communication, social interaction, personality, and artistic expression. The vocal instrument is comprised of the vibratory body, the respiratory power source, and the oropharyngeal resonating chamber. The lungs are the power supply, the larynx is the vibratory source, and the supraglottal vocal tract (supraglottal pharynx oral cavity, nasal cavity) is the resonator that shapes the sound into words and songs. During the phase of expiration as the diaphragm relaxes and the chest wall recoils, air is pushed through the nearly closed vocal folds. The aerodynamic forces of the air column and myoelastic properties of the vocal folds are responsible for the repeated opening and closing of the glottal tissue that pulses that air column as it flows out. These disruptions in the steady state of tracheal air pressure by glottal activity and vocal fold vibrations result in voice production. Voice is characterized by its frequency intensity and harmonics. The harmonics are hormonally dependent. This is illustrated by changes that occur during male and female puberty. The female voice evolves from childhood to menopause under the varied influences of estrogen, progesterone, and testosterone. These hormones are the dominant factor in determining voice changes throughout life. Female voice has a fundamental frequency one-third lower than that of a child. In males, androgen released at puberty is responsible for the male vocal frequency being an octave lower than that of a child. The females have a reproductive system, which undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The main objective of this experiment is to provide a solid ground with evidence of changes in voice because of sexual hormones, which will form the base of a multidisciplinary approach to a comprehensive and integrated understanding of premenstrual and menopausal female voice.

Functional consequences of novel connexin 26 mutations associated with hereditary hearing loss.

In a study of 530 individuals with non-syndromic, sensorineural hearing loss, we identified 18 mutations at connexin 26 (Cx26), four of which are novel (−23G>T, I33T, 377_383dupTCCGCAT, W172R) and the remaining 14 (ivs1+1G>A, M1V, 35delG, W24X, I35S, V37I, R75W, W77X, 312del14, E120del, Q124X, Y136X, R143W, R184P) being mutations previously described. To gain insight into functional consequences of these mutations, cellular localization of the mutant proteins and their ability to permit lucifer yellow transfer between cells was studied in seven of them (W24X, I33T, I35S, R75W, E120del, W172R and R184P). I35S and R184P showed impaired trafficking of the protein to the plasma membrane. I33T, R75W, E120del and W172R showed predominantly membrane localization but did not form functional gap junction channels. Surprisingly, W24X, a protein-truncating mutation, apparently permits formation of a full-length protein, perhaps due to a stop codon read-through mechanism. These results provide further evidence that Cx26 mutations affect gap junction activity by mis-regulation at multiple levels.

A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35,000 per month. Three thousand children between the ages of 5-12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.

Non-syndromic hearing impairment in India: high allelic heterogeneity among mutations in TMPRSS3, TMC1, USHIC, CDH23 and TMIE.

Mutations in the autosomal genes TMPRSS3, TMC1, USHIC, CDH23 and TMIE are known to cause hereditary hearing loss. To study the contribution of these genes to autosomal recessive, non-syndromic hearing loss (ARNSHL) in India, we examined 374 families with the disorder to identify potential mutations. We found four mutations in TMPRSS3, eight in TMC1, ten in USHIC, eight in CDH23 and three in TMIE. Of the 33 potentially pathogenic variants identified in these genes, 23 were new and the remaining have been previously reported. Collectively, mutations in these five genes contribute to about one-tenth of ARNSHL among the families examined. New mutations detected in this study extend the allelic heterogeneity of the genes and provide several additional variants for structure-function correlation studies. These findings have implications for early DNA-based detection of deafness and genetic counseling of affected families in the Indian subcontinent.

Prevalence of preventable ear disorders in over 15,000 schoolchildren in northern India.

BACKGROUND There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India. METHOD A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry. RESULTS Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children. CONCLUSION Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.

COCHLEAR IMPLANTATION IN INDIA: A PUBLIC HEALTH PERSPECTIVE

Around 7% of the population of India suffers from profound deafness. More than a million children needs either hearing aid or cochlear implant surgery to restore their hearing power. Many of them had never heard a single word since their birth. Still only 5000 cochlear implant surgery has been conducted in the country, the first being nearly 20 years ago, and most of them in private health facilities where the patient paid out of their pocket. The main reason of such poor penetration of the surgery in masses is the inhibitory cost associated with cochlear implant surgery and the lack of trained man-power to conduct such surgeries. The other reason is being the government engagement with other pressing health needs of the society resulting in the shout of ear care falling on deaf ears. With the advent of National Program for Prevention and Control of Deafness (NPPCD) in 2006, there is renewed interest in tackling this public health disaster.

Neonatal hearing screening OTOLARYNGOLOGIST’S PERSPECTIVE

1. Nelson HD, Bougatsos C, Nygren P. Universal newborn Hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008;122:e266-76. 2. American Academy of Pediatrics, Joint Committee on Infant Hearing Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898-921. 3. Canale A, Favero E, Lacilla M, Recchia E, Schindler A, Roggero N, et al. Age at diagnosis of deaf babies: A retrospective analysis highlighting the advantage of newborn hearing screening. Int J Pediatr Otorhinolaryngol. 2006:70:1283-9. 4. Pimperton H, Kennedy CR. The impact of early identification of permanent childhood hearing impairment on speech and language outcome. Arch Dis Child. 2012;97:648-53. 5. Vohr BR, White KR, Maxon AB, Johnson MJ. Factors affecting the interpretation of transient evoked otoacoustic emission results in neonatal hearing screening. Semin Hearing. 1993;14:57-72. 6. Patel H, Feldman M. Universal newborn screening. Paediatr Child Health. 2001;16:301-5. 7. Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. Neonatal hearing screening – Experience from a tertiary care hospital in Southern India. Indian Pediatr. 2014;51:179-83. 8. Mukhari SZ, Tan KY, Abdullah A. A pilot project on hospital-based universal newborn hearing screening: Lessons learned. Int J Pediatr Otorhinolaryngol. 2006;70:843-51.

Prevalence of ear diseases in the children of Delhi.

OBJECTIVE This study aimed to assess the prevalence and profile of ear diseases in children from Delhi, India. METHODS A population-based cross-sectional door-to-door survey was carried out in two districts of Delhi, and involved children of all demographic sections of the region. A total of 4626 children aged between 18 days and 15 years underwent examinations including otoscopy, impedance audiometry and hearing screening. RESULTS In all, 14.8 per cent of the study sample was diagnosed with one or more ear morbidities, the most common being cerumen impaction (7.5 per cent) and chronic suppurative otitis media (3.6 per cent). There was clinical evidence of otitis media with effusion in 2 per cent of children, and 0.96 per cent had otitis externa (bacterial and fungal). The point prevalence of acute suppurative otitis media was 0.39 per cent. In all, 0.45 per cent of children were found to have an undiagnosed foreign body within the ear canal. CONCLUSION The high prevalence of ear disease poses a significant public health problem in Delhi.

Comparative prevalence of otitis media in children living in urban slums, non-slum urban and rural areas of Delhi.

PURPOSE The study aimed to determine the prevalence and profile of otitis media in different parts of a city, i.e. non-slum urban areas, urban slums and rural areas. METHODOLOGY A door to door survey was conducted in identified areas of Delhi. A total of 3000 children (0-15 years) were randomly selected and examined for presence of otitis media. These children were equally distributed in the three areas under consideration. Data was analyzed to establish the prevalence of different types of otitis media. Chi-square test was then applied to compare disease prevalence among the three areas. RESULTS 7.1% of the study population was identified with otitis media, which includes CSOM (4.26%), OME (2.5%) and ASOM (0.4%). In the non-slum urban parts of the city, 4.6% children had otitis media. This was significantly lower compared to 7% children in rural parts of Delhi and 9.9% in urban slums of the city. The prevalence of CSOM was considerably higher in slum areas (7.2%) as compared with rural (3%) and non-slum urban areas (2.6%). CONCLUSION Ear infections are significantly more common in urban slums as compared to non-slum city areas and rural parts of Delhi.

An amazing gunshot injury of the head and neck

As the use of firearms has become more prevalent in society, both the number of homicidal & suicidal victims has increased Injuries from gunshot wounds, of the face and neck vary in extent and significance, forming a spectrum from trivial to life-endangering lesions. The face and the neck have many vital structures confined to a small area of the body, and hence, it has a greter potential of leading to a fatality in the event of trauma. We report a case of a civilian homicidal firearm injmy sustained in the head & neck region, with the bullet having travelled through the head & neck region without causing any mortality and minimal morbidity to the victim