This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.

Background:The purpose of this study was to classify various types of non-neoplastic and neoplastic lesions presenting as sinonasal mass and characterize their clinico-pathological profile in a tertiary care center in the state of Uttarakhand.Materials and Methods:This was a prospective study where 110 cases of sinonasal masses were included over a period of 12 months. Clinico-pathological study was carried out in these cases. A provisional diagnosis was made after clinical assessment and radiologic investigations, but final diagnosis was made after histopathologic examination.Observations:The number of non-neoplastic lesions were more than the neoplastic lesion, 60% versus 40% respectively. In the neoplastic group, 19.8% and 23.76% patients presented with benign and malignant lesion, respectively. The incidence was more predominant in the age group of 11-20 years (22.72%) with male to female ratio of 1.08:1. In our study, among non-neoplastic lesions the occurrence of sinonasal polyps was highest seen in 80.30% cases. In neoplastic lesions, angiofibroma was most common benign lesion seen in 35% cases. Carcinoma nasal cavity was the commonest malignant lesion seen in 45.83% cases. In 3.63% patients, clinical and radiologic diagnosis was not correlated with histopathologic diagnosis. Only two cases required immuno-histocytochemistry to confirm the final diagnosis.Conclusion:We concluded that for proper evaluation of a sinonasal mass, clinical, radiologic, and histopathologic evaluation should be carried out conjointly in all the cases. Histopathology always gives a confirmatory diagnosis but in few cases immuno-histocytochemistry becomes the ultimate diagnostic technique for correct and timely intervention.

Keywords: Antibiotics; chronic otitis media; microbiologyDOI: 10.3126/njenthns.v1i2.4758 Nepalese J ENT Head Neck Surg Vol.1 No.2 (2010) p.14-16

Increased plasma level of von Willebrand Factor (vWF) is associated with major cardiovascular diseases. We previously reported that multimeric vWF binds to NO synthase and inhibits insulin-induced production of NO, thus promoting insulin resistance during acute hypoxia (AH). However, the transcriptional regulation of vWF during AH is not clearly understood. Here, we investigated the mechanisms underlying the upregulation of vwf in mice. AH significantly upregulates the tlr2, tlr3, myd88, and vwf expression and phosphorylation of specificity protein 1 (SP1). Furthermore, AH significantly upregulates high mobility group box-1 (HMGB1) in a time-dependent manner. Moreover, a TLR2 agonist upregulates vWF but a TLR3 agonist does not. Pretreatment with an HMGB1 inhibitor, TLR2-immunoneutralizing antibody, or SP1 inhibitor significantly inhibits vWF expression. Furthermore, Tlr2 silencing completely inhibited MYD88, vWF expression, and SP1 phosphorylation. However, pretreatment with glycyrrhizic acid or silencing of Tlr2 completely blocks binding of Sp1 to the Vwf promoter, thus inhibiting its expression, and enhances insulin resistance during AH. Patients with type 2 diabetes mellitus also showed significantly elevated levels of HMGB1, TLR2, SP1, and vWF, thereby supporting the results of the murine model of AH. Taken together, HMGB1 upregulates vWF in vivo through the TLR2-MYD88-SP1 pathway in mice.

The purpose of this study was to identify patients of vocal cord paralysis and to establish an etiological diagnosis. Patients with vocal cord paralysis have been followed prospectively at a tertiary referral center. 120 patients identified with vocal cord paralysis by laryngeal endoscopy were evaluated clinically, radiologically and pathologically to make an etiological diagnosis. Those patients in whom no cause was found, a CT scan from base of skull to thorax was done before labeling them as idiopathic. Most of the patients presented in 5th (26.67 %) and 6th (21.67 %) decade. Males out numbered females in the ratio 2.3:1.0. The most common symptom of vocal cord paralysis was change in voice (98.21 %). Bilateral vocal cord palsy was found in 6.67 % patients and unilateral vocal cord palsy was found in 93.33 % patients. Among patients of unilateral vocal cord paralysis left vocal cord was paralyzed in 69.64 % and right cord in 30.36 %. Malignant (34.16 %) causes accounted for largest number of patients followed by central (15.00 %) and idiopathic causes (14.16 %). VCP has got a variable etiology which varies with the laterality of the vocal cord involvement. Malignant causes predominated in our series, occurring in 34.16 %, followed by central and idiopathic causes.

COVID-19 epidemic has varied spectrum of symptoms. With this study we aim to evaluate prevalence of Olfactory and Gustatory dysfunction in COVID-19 patients. To assess Olfactory and Gustatory dysfunction in COVID-19 Patients in Indian Population. Settings and Design: Prospective observational study. RT-PCR proven COVID-19 patients were enrolled in the study. Detailed history and olfactory function and Taste function were evaluated. Patient with symptoms of olfactory dysfunction were subjected to fill (sQOD-NS questionnaire). Re-evaluation was done weekly till the time of discharge. Analysis was done with Wilcoxon test with help of SPSS software. A total of 152 patients (Male-78, Female-74) completed the study after weekly evaluation. Olfactory and Gustatory dysfunction was seen in 28 (18.41%) and 20 (13.15%). Mean duration of symptoms was 2.4444 ± 0.352 days. Olfactory dysfunction was the first presenting symptom in 11 out of 152 patients (7.23%). Mean QD-NOS score in patients with Anosmia and Hyposmia (28 patients) was 11.4 ± 2.01 and 13.61 ± 2.82 at 1st evaluation, 20.3 ± 1.49 and 20.33 ± 1.57 at 7th day and 21 in both subgroups at 14th day follow up. Dysgeusia was noticed in 20/152 patients (13.15%). Recovery in olfactory dysfunction and Dysgeusia was complete in all patients. Olfactory and gustatory dysfunctions are significant part of clinical spectrum of COVID-19 disease In Indian Population.

<p class="abstract"><strong>Background:</strong> Deep Neck Space Infections (DNSI) are serious diseases that involve several spaces of neck. Commonest sources of DNSI are dental and oropharyngeal infections. With widespread use of antibiotics, the prevalence of DNSI has been reduced but odontogenic DNSI are still common due to poor oral hygiene. Management mainly comprises of airway management, antibiotic therapy and surgical intervention. This study was conducted to find out the prevalence, distribution, presentation, sites involved, bacteriology and management of odontogenic DNSI.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was done from October 2010 to January 2013 and included 76 patients with DNSI. Then, etiological factors of DNSI were studied and prevalence of odontogenic DNSI was calculated. All parameters including age, sex, co-morbidities, presentation, site, bacteriology and interventions required in odontogenic DNSI cases were studied.</p><p class="abstract"><strong>Results:</strong> Odontogenic infections were the most common etiological factor in DNSI, with a prevalence of 34.21% among DNSI. Toothace was commonest symptom, followed by neck swelling, pain and odynophagia. Submandibular space involvement (42.30%) was the most common clinical presentation of odontogenic DNSI patients, followed by Ludwig’s angina and masticator abscess.</p><strong>Conclusions:</strong> DNSI are common and life threatening infections. For management, early diagnosis is essential. In developing countries majority of DNSI are of odontogenic origin. In our country lack of adequate nutrition, poor orodental hygiene, tobacco and beetle nut chewing and smoking has increased the prevalence of odontogenic DNSI. So, prevention of odontogenic DNSI can be achieved by making population aware of oral and dental hygiene and by conducting regular check-up camps at community level.

Sterile Inflammation (SI), a condition where damage associated molecular patterns (DAMPs) released from dying cells, leads to TLR (Toll-like receptor) activation and triggers hypoxemia in circulation leading to venous thrombosis (VT) through tissue factor (TF) activation, but its importance under acute hypoxia (AH) remains unexplored. Thus, we hypothesized that eRNA released from dying cells under AH activates TF via the TLR3-ERK1/2-AP1 pathway, leading to VT. Animals were exposed to stimulate hypoxia for 0-24 h at standard temperature and humidity. RNaseA and DNase1 were injected immediately before exposure. TLR3 gene silencing was performed through in vivo injection of TLR3 siRNA. 80 μg/kg BW of isolated eRNA and eDNA were injected 6 h prior to sacrifice. Antigens of TF pathway were determined by ELISA and TF activity by a chromogenic assay. AH exposure significantly induced release of SI markers i.e. eRNA, eDNA, HMGB1 and upregulated TLR3, ERK1/ 2 (Extracellular signal-regulated kinases), AP1 (Activator Protein-1) and TF, whereas RNaseA pre-treatment diminished the effect of AH, thus inhibiting TF expression as well as activity during AH. Hence, we propose a possible mechanism of AH-induced TF activation and thrombosis where RNaseA can become the novel focal point in ameliorating therapy for AH induced thrombosis.