<p class="abstract"><strong>Background:</strong> The introduction of the operating microscope has significantly enhanced the outcome of tympanoplasty by improving the accuracy of the technique. The operating microscopy provides a magnified image in straight line; hence the surgeon can’t visualize the deep recesses of the middle ear in single operating field. This is overcome by use of rigid endoscope for tympanoplasty. In rigid endoscopy view is better but surgeons 2 hands are not free so manipulation here is difficult.</p><p class="abstract"><strong>Methods:</strong> 30 cases of safe CSOM from each group viz microscopic assisted (MES) & endoscopic assisted (EES) were selected operated by full cuff (superiorly based tympanomeatal flap technique) and compared for graft uptake, hearing improvement & complications.</p><p class="abstract"><strong>Results:</strong> Graft uptake rate was 93.33% in both groups. In our study the pre operative mean air bone gap of the patients was 37.23+5.79 db after surgery at 6 months came down to 17.17+3.31 db hence after calculating the mean air bone gap closure it came down to be 20.4+4.85. Which showed a significant improvement in the hearing (p value 1.493E-23 which is less than 0.05). 6.67% cases from both groups showed failure of graft uptake.</p><p><strong>Conclusions:</strong> The graft uptake, hearing improvement, Complications produced by each of the techniques in large, subtotal, and anterior moderate perforations by each technique is comparable i.e. both techniques have same results.</p>
Objective: The risk of invasive fungal rhinosinusitis is increased in Coronavirus disease 2019 (COVID-19) because of its direct impact in altering innate immunity and is further exacerbated by widespread use of steroids/antibiotics/monoclonal antibodies. The study aims to describe this recently increased clinical entity in association with COVID-19. Method: A prospective, longitudinal study including patients diagnosed with acute invasive fungal rhinosinusitis (AIFRS) who recently recovered from COVID-19 infection or after an asymptomatic carrier state. A single-center, descriptive study investigating demographic details, clinical presentation, radio-pathological aspects, and advocated management. Result: A total of 21 patients were included with a mean age of 49.62 years (SD: 14.24). Diabetes mellitus (DM) was the most common underlying disorder (90.48%), and 63.16% of all patients with DM had a recent onset DM, either diagnosed during or after COVID-19 infection. Nineteen patients (90.48%) had recently recovered from active COVID-19 infection, and all had a history of prior steroid treatment (oral/parenteral). Remaining 2 patients were asymptomatic COVID-19 carriers. Surprisingly, 2 patients had no underlying disorder, and 5 (23.81%) recently received the Covishield vaccine. Fungal analysis exhibited Mucor (95.24%) and Aspergillus species (14.29%). Most common sign/symptom was headache and facial/periorbital pain (85.71%), followed by facial/periorbital swelling (61.90%). Disease involvement: sinonasal (100%), orbital (47.62%), pterygopalatine fossa (28.58%), infratemporal fossa (14.29%), intracranial (23.81%), and skin (9.52%). Exclusive endoscopic debridement and combined approach were utilized in 61.90% and 38.10%, respectively. Both liposomal amphotericin B and posaconazole were given in all patients except one. Conclusion: A high suspicion of AIFRS should be kept in patients with recent COVID-19 infection who received steroids and presenting with headache, facial pain, and/or facial swelling. Asymptomatic COVID-19 carriers and COVID-19 vaccinated candidates are also observed to develop AIFRS, although the exact immuno-pathogenesis is still unknown. Prompt diagnosis and early management are vital for a favorable outcome.
Background: A rise in secondary fungal infections during the COVID-19 pandemic necessitates a deeper understanding of the associated immunological perturbations. Objectives: To evaluate the clinical and immunological characteristics observed in patients with COVID-19 associated mucormycosis (CAM) infection. Patients/ Methods: Cases of mucormycosis with or post-COVID-19 infection were compared with cases of acute COVID-19 and convalescent COVID-19. Lymphocyte subsets, cytokines and other laboratory markers were compared between the groups. Results:The frequency of proposed risk factors for CAM was diabetes mellitus (77%), recent history of steroid use (69%) and hypoxia during COVID-19 infection (52%).Iron metabolism was dysregulated in CAM patients with low TIBC and total iron. Further, CAM was accompanied with lymphopenia with drastic reduction in B cell counts; however, plasmablasts were not altered. Further, CAM patients had low immunoglobulin levels and antibodies specific to mucor peptide did not increase in CAM suggesting dysfunction in B-cell response. There was increase in activated effector cytotoxic CD8 T cells and NK cells in CAM compared with COVID-19 infection and healthy controls. Among T helper cells, Tregs were reduced and Th-1 frequency was
The incidence of Stylalgia is higher in a female population. Elective management of patients after assessing the response to treatment, and then offering surgical management is of value for adequate patient care, prevention of unnecessarily delayed diagnosis and appropriate treatment.
Posttraumatic external carotid artery pseudoaneurysm with arteriovenous fistula is a rare condition. An 8-year-old child presented with painful pulsatile swelling in the preauricular region following a penetrating glass shrapnel injury. Detailed evaluation showed distal external carotid artery pseudoaneurysm with fistula, which was draining into the retromandibular vein. Endovascular treatment was performed. This case highlights the role of endovascular intervention for such rare complicated vascular pathologies.
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