Vocal Cord Paralysis –An Etiological Analysis

 

Abstract

Introduction: Vocal cord paralysis is the total interruption of nerve impulse resulting in absence of laryngeal muscle movement. The most common type of vocal cord paralysis found is due to recurrent laryngeal nerve injury. The pathology can be either along the course of the tenth cranial nerve from cerebral cortex to neuromuscular junction or could be from mechanical fixation of cricoarytenoid joint.

Objective: To study the various etiological factors contributing to vocal cord paralysis.

Materials and methods: Patients with vocal cord paralysis [unilateral and bilateral] who were treated at a tertiary institute for a period of 3 years were included. The immobility of cords was assessed with the use of indirect laryngoscopy via mirror or rigid angled telescopy or flexible laryngoscopy. The patients were categorized based on laterality of paralysis as well as based on various etiological factors into groups. Appropriate statistical analysis was done.

Results: Among 50 patients, 84 % cases had unilateral vocal cord paralysis. Surgical cause was found to be the most common etiology of unilateral vocal cord paralysis (34%) closely followed by idiopathic (18%) and neoplasm (16%). In bilateral vocal cord paralysis, surgical and neurological causes were found to be the main causative factor.

Conclusion: Vocal cord paralysis has a wide range of factors contributing to its occurrence with surgical cause being a common one. A comprehensive assessment of patient should be performed to determine the cause which facilitates a direct treatment plan.

Keywords:Vocal cord paralysis; etiologyb

Abbreviations:VCP: Vocal Cord Paralysis; RLN: Recurrent Laryngeal Nerve; UVCP: Unilateral Vocal Cord Paralysis

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Mastoid Exploration in the Management of Chronic Otitis Media with Complications

 

Abstract

Chronic suppurative otitis media is a common problem in developing countries. Complications due to chronic suppurative otitis media still pose a major problem in the developing countries. In cases of chronic suppurative otitis media associated with complications, after managing the complications, mastoid exploration should be done to remove the primary source of infection. Planning of mastoid exploration play an important role in the management. Here the management of primary otogenic septic foci, after the management of extracranial and intracranial complications is discussed.

Keywords:Mastoid exploration; otitis media; complications

 

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Lupine Publishers | Acute Infectious Cervical Lymphadenitis of Children in A Tropical Country

 

Abstract

Introduction: The volume increase of a cervical lymph node is frequent in infancy .It is most often secondary to a benign infection of the upper aerodigestive tracts [1,2]. It is a medical and surgical emergency frequently encountered in developing countries, despite the generalization of antibiotics. Its gravity depends on the virulence of the germ and the fragility of the patient.

Patients and Methods: It’s about a retrospectively study of all the medical files records of patients under 16 years old hospitalized at the ENT department of Fann Teaching Hospital for the management of infectious cervical lymphadenitis . The studied period is January 1st, 2008 to November 30th, 2017.

Results: We had collected 83 medical files of patients with acute infectious cervical lymphadenitis including 66 cases of suppurative acute lymphadenitis and 17 cases of simple acute adenitis (uncollected). The average age of our patients was 2.4 years with extremes ranging from 1 month to 16 month. The location of swelling was the submandibular region in 57 patients, upper jugular area in 8 patients and submental region in 6 patients. Stapphyloccocus aureus is the most frequent bacteria found in 29 cases. Initial antibiotic therapy consisted of the association of amoxicillin/clavulanic. A favorable evolution marked by an apyrexia after 48h of treatment with regression of the swelling and a resumption of the feeding was noted in 92% of the cases. We deplored two cases of death.

Conclusion: Acute adenitis is frequent in pediatric otorhinolaryngology. It is often secondary to oropharyngeal infections, dental and skin diseases. The treatment is essentially based on antibiotics.

Keywords:Acute lymphadenitis; pediatric infection; cervical lymph’s nodes

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Olfactory Outcome After Endoscopic Sinus Surgery in Chronic Rhinosinusitis

 

Abstract

Background: Olfactory dysfunction is one of the major symptoms of CRS. Olfactory dysfunction affects the quality of life. Endoscopic sinus surgery is the surgical modality of treatment in cases of failed medial therapy. Assessment of olfaction in patients undergoing endoscopic sinus surgery is essential to know the impact on olfaction.

Objective: To assess the olfaction before and after Endoscopic sinus surgery.

Methods: This is a prospective study. Total 45 Patients were included in this study based on the inclusion and exclusion criteria. Diagnostic nasal endoscopy and CT scan were done preoperatively. Olfaction was assessed in all patients preoperatively, postoperatively at 1month and 3 months using olfactory testing tool.

Results: There were 45 patients of both gender 57.78% were females and 42.22% were males. The mean age of patients in our study was found to be 39.82±6.264 years. Most of these patients were in fourth decade of life. Of 45 patients 75% had symptoms of hyposmia/anosmia before surgery. Average Lund Mackey score for CT scan findings was found to be 13.42 ± 3.1. The patients were assessed postoperatively at 1st month and 3rd month using olfactory testing tool. The mean composite olfactory score was 5.83±2.89 preoperatively increased to 8.28± 2.33 at 1 month and 10.12 ±1.11 at 3 months, this difference was found to be statistically significant (p < 0.001). All patients mean olfactory scores improved postoperatively. The mean composite olfactory scores improved following endoscopic sinus surgery by 3.5 in Anosmic patients, 2.22 in Hyposmic patients and 1.04 in Normosmic at 1 month. Whereas at 3 months, 6.65, 3.22 and 1.95 in Anosmic, Hyposmic and Normosmic patients, respectively. The study was an attempt to assess the olfaction preoperatively and postoperatively in patients undergoing ESS.

Conclusion: The evaluation of olfaction in patients undergoing endoscopic sinus surgery showed improvement in olfactory outcome following the surgery in patients with CRS. 61% to 69% of CRS patients have a reduced sense of smell. Approximately two thirds of cases are due to the sinonasal disease. Olfactory dysfunction as result of sinonasal disease is unlikely to improve spontaneously without treatment.

Keywords: Olfaction; endoscopic sinus surgery; chronic rhino sinusitis

Abbreviations: CRS: Chronic Rhinosinusitis; ESS: Endoscopic Sinus Surgery; CCCRC: Connecticut Chemosensory Clinical Research Centre 

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Ossiculoplasty Using Preserved Septal Cartilage

 

Abstract

Ossicular chain reconstruction is the primary method of restoring conductive hearing deficit seen in chronic middle ear disease. Many factors affect outcomes in this procedure including the middle ear environment, status of the Eustachian tube, surgical technique, type of prosthesis and status of residual ossicular remnants. Many materials have been used for Ossiculoplasty including both biologic and alloplastic materials, with varying degrees of success. This study was done to evaluate the efficacy of preserved septal cartilage as ossicular reconstruction prosthesis in patients with mucosal type of COM (chronic otitis media) with ossicular discontinuity.

Objective: To evaluate the efficacy of preserved septal cartilage as ossicular reconstruction prosthesis in patients with mucosal type of COM with ossicular discontinuity.

Materials and Methods: A prospective study of 20 patients with mucosal type of COM, undergoing Ossiculoplasty was conducted at a teaching tertiary care hospital from January 2019 to July 2020.

Results: A total 20 patients (13 males and 7 females) between the age group of 18-60 years with mucosal type of COM with ossicular discontinuity were included in the study. Out of 20 patients 18 patients (90%) had improvement in A-B gap (air bone gap) after surgery and 2 patients had no improvement in A-B gap after 3 months of follow up. The mean hearing gain was 12.25±7.23 dB which was statistically significant (p value 0.001).

Conclusion: Preserved septal cartilage is a good material for ossicular reconstruction in terms of postoperative hearing improvement and closure of A-B gap. By giving careful attention to the principles of ossicular construction and understanding basic principles and applying them in clinical practice, it is possible to give more desirable hearing results for the patients.

Keywords:Ossiculoplasty, septal cartilage

Abbreviations: COM: Chronic Otitis Media

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Trazodone Not Only A Stabilizer in Allergic Rhinitis

 

Letter to Editor

We report the case of a 44 years old woman referred to the outpatient Sleep Disorder Service of the Neurological Clinic, Marche Polytechnic University for a symptomatology characterized by difficulty in maintaining sleep and a feeling of unrefreshing sleep on waking. On clinical history, she referred an allergic rhinitis, treated with short cycles of inalatory steroids and vasoconstrictors. At the moment of our observation, she did not assume any treatment [1]. Due to the reported symptoms, particular attention was paid to the possible presence of sleep disturbances, in particular sleep-related breathing disorders. In this respect, patient reported a morning dry mouth. Further, the partner referred an important snoring and continuous lightening of sleep. Nocturnal apnea events were not reported as well as discomfort or abnormal movements in the legs. No other disturbance suggestive for NREM or REM sleep disturbances, nor fewer specific phases were evidenced. Patient was then submitted to a polygraphy which showed a rhonchopathy associated with air flow limitations, a high arousal index and elevated heart rate variability. The exam excluded periodic limb movements (Figure 1) [2,3]. Considering the history of allergic rhinitis and also to evaluate the possible presence of anomalies of the upper airways, an ENT assessment was indicated. Further, in relation to the difficulty in maintaining sleep and for the high indices of autonomic dysfunction, a pharmacological treatment with trazodone at the dose of sleep stabilizer, 30 mg in the evening was prescribed.
ENT evaluation showed a pattern of nasal congestion without other alteration of the upper airways. Specific topical therapy was prescribed, not taken by the patient for the improvement with trazodone. Infact after few days of treatment with trazodone the patient reported a significant improvement of symptomatology and after 30 days a poligraphic control showed a complete recovery of respiratory alterations and a normalization of autonomic dysfunction (Figure 2) [4]. The particularly favorable and rapid evolution of patient’s symptomatology could be interpreted on the basis of the pharmacological properties of trazodone. It is possible to hypothesize that trazodone at low dosages, in addition to the anxiolytic and hypno-inducing effect, for its an antihistamine action was able to contemporary solve clinical pictures related to both insomnia and the respiratory dysfunction [5]. Therefore, trazodone, in addition to stabilizing the sleep structure by increasing the arousal threshold, should deserve consideration in patients affected by allergic rhinitis with sleep disturbances. The advantage of having a valid therapeutic alternative would be very important in relation to the fact that steroids and vasoconstrictors, normally used in the treatment of allergic rhinitis, find an indication only in the short-term approach and have no effect on sleep disturbances.

Keywords: Obstructive sleep apnea; flow limitation; allergic rhinitis; trazodone; polygraphy

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Excessive Fear/ Psychological Threat of Getting Covid-19 Infection in People Can Lead to Accidental Foreign Bodies in Nose During Screening and Sampling

 

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The cases of Covid 19 are increasing daily since last 8 to 9 months due to which testing has also been increased and the incidence of accidental foreign body (swab stick) in the nose and mouth has also been seen during screening and sampling.

Case Report: This paper shows complication of viral swab testing during sampling of suspected irritable, anxious, and stressed Covid 19 patients as swab stick breaks at the indentation point while taking Nasopharyngeal and Oropharyngeal samples resulting in impaction in the nasal cavity or mouth.

Conclusion: This paper highlights various ideas to reduce the chances of accidental foreign body in the nasal cavity and mouth during sampling of suspected covid 19 patients.

Keywords: Covid-19; psychological threat; nasopharyngeal sampling; foreign bodies

Abbreviations: NP: Nasopharyngeal; OP: Oropharyngeal; FB: Foreign Body; ENT: Ear Nose Throat; PPE- Personal Protective Equipment’s 

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