Allergic rhinitis (AR) is a global health problem and its impact on health related quality of lif... more Allergic rhinitis (AR) is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites (80%) followed by cockroaches (67%). All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues.
Page 1. Saccular Cyst s~ Repiratory distress in neonates with stridor, apparent immediately after... more Page 1. Saccular Cyst s~ Repiratory distress in neonates with stridor, apparent immediately after birth is caused by major airway obstruction like bilateral choanal atresia, bilateral vocal cord paralysis, large saccular cysts or major ...
... Ashish Goel & Shoma V. Rao & Mary S. Mathews &amp... more ... Ashish Goel & Shoma V. Rao & Mary S. Mathews & Alice George & Mary Kurien & Anika Amritanand & Vinodh P. Masilamani & Uday Zachariah & CE Eapen ... 5. Rathi U, Bapat M, Rathi P, Abraham P. Effect of liver disease on maternal and fetal outcome—a prospective study. ...
A 21-year-old nonsmoker, nondiabetic, normotensive man with no family history of coronary artery ... more A 21-year-old nonsmoker, nondiabetic, normotensive man with no family history of coronary artery disease presented with an 8year history of palpitation and progressive angina on exertion. There was no history of pain while at rest. Clinical examination revealed normal systemic blood pressure and bounding peripheral pulses. Systemic examination revealed a hyperdynamic apex with a localized continuous murmur of grade 3/6 in left fourth and fifth intercostal space near the left parasternal region. ECG revealed left ventricular hypertrophy without significant ST-T wave changes.
International Journal of Pediatric Otorhinolaryngology, 2016
To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study i... more To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis. Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system. 152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD-3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media. The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.
Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. ... more Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year. Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our su...
International Journal of Biomedical Research, Jan 30, 2015
The Objectives: To determine the age of suspicion, confirmation and amplification of hearing hand... more The Objectives: To determine the age of suspicion, confirmation and amplification of hearing handicap in children and to assess the burden of parental delay in the evaluation of hearing loss. Methods: A prospective study was done at a tertiary academic hospital in South India on 61 children with bilateral sensory neural deafness who either warrant hearing aid fitting for amplification or those hearing aids found ineffective. Any significant motor, visual, sensory or genetic disorders were excluded. Interviewer administered a questionnaire to the parents, guardian or older children for evaluations of their awareness and knowledge of the special needs. Pure tone audiometry was done for all children older than 5 years and Auditory Brainstem Evoked Response (ABER) audiometry was done in those younger than 5 years and older children who were mentally challenged. All the children were prescribed hearing aid after a trail and those who were already aided were evaluated for the performance of the aid. From the data, the age of suspicion, identification and the amplification were determined. The various factors were noted; data entered and analyzed using Statistical Programme for Social Science (SPSS -Version 6). Design: Prospective case study Results: The mean age in months at first suspicion, identification and the amplification was 19.59 months, 24.82 months and 29.28 months respectively. The average delays between the age of suspicion and identification was 5.23 months and the time interval between the identification and amplification was 4.46 months. In 70.48% of children the hearing loss was suspected after one year of age and only 1.6% have confirmed to have hearing loss and amplified before 6 months. Conclusion: The substantial parental delay of suspicion and its subsequent delay in identification and the amplification of childhood deafness indicate that the attainable realistic goal of EHDI has not yet been achieved. Setting up EHDI through UNHS is a challenge in developing countries, however an unavoidable strategy. Hence cost effective national policies with community support should be considered to give greater chance of linguistic, psychological and social development to the hearing impaired children.
To evaluate the efficacy and safety of intranasal midazolam and chloral hydrate syrup for procedu... more To evaluate the efficacy and safety of intranasal midazolam and chloral hydrate syrup for procedural sedation in children. Prospective randomized placebo-controlled trial (double blind, double dummy). Tertiary care hospital over 18 months. Eighty-two children, 1 to 6 years old, undergoing auditory brainstem response testing were randomized to receive either intranasal midazolam with oral placebo or chloral hydrate syrup with placebo nasal spray. Intranasal midazolam was delivered at 0.5 mg/kg (100 mcg per spray) and oral syrup at 50 mg/kg. Children not sedated at 30 minutes had a second dose at half the initial dose. The primary outcomes measured were safety and efficacy. Secondary outcomes were time to onset of sedation, parental separation, nature of parental separation, parental satisfaction, audiologist's satisfaction, time to recovery, and number of attempts. Forty-one children were in each group, and no major adverse events were noted. The chloral hydrate group showed earlier onset of sedation (66%) compared with the intranasal midazolam group (33%). Significant difference in time to recovery was noted in the chloral hydrate group (78 minutes) versus the intranasal midazolam group (108 minutes). The parents' and audiologist's satisfaction was higher for chloral hydrate (95% and 75%) than for intranasal midazolam (49% and 29%, respectively). Overall, sedation was 95% with chloral hydrate versus 51% with intranasal midazolam. Both drugs maintained sedation. Intranasal midazolam and chloral hydrate are both safe and efficacious for pediatric procedural sedation. Chloral hydrate was superior to intranasal midazolam, with an earlier time to onset of sedation, a faster recovery, better satisfaction among parents and the audiologist, and successful sedation.
International Journal of Biomedical Research, 2015
The Objectives: To determine the age of suspicion, confirmation and amplification of hearing hand... more The Objectives: To determine the age of suspicion, confirmation and amplification of hearing handicap in children and to assess the burden of parental delay in the evaluation of hearing loss. Methods: A prospective study was done at a tertiary academic hospital in South India on 61 children with bilateral sensory neural deafness who either warrant hearing aid fitting for amplification or those hearing aids found ineffective. Any significant motor, visual, sensory or genetic disorders were excluded. Interviewer administered a questionnaire to the parents, guardian or older children for evaluations of their awareness and knowledge of the special needs. Pure tone audiometry was done for all children older than 5 years and Auditory Brainstem Evoked Response (ABER) audiometry was done in those younger than 5 years and older children who were mentally challenged. All the children were prescribed hearing aid after a trail and those who were already aided were evaluated for the performance of the aid. From the data, the age of suspicion, identification and the amplification were determined. The various factors were noted; data entered and analyzed using Statistical Programme for Social Science (SPSS -Version 6). Design: Prospective case study Results: The mean age in months at first suspicion, identification and the amplification was 19.59 months, 24.82 months and 29.28 months respectively. The average delays between the age of suspicion and identification was 5.23 months and the time interval between the identification and amplification was 4.46 months. In 70.48% of children the hearing loss was suspected after one year of age and only 1.6% have confirmed to have hearing loss and amplified before 6 months. Conclusion: The substantial parental delay of suspicion and its subsequent delay in identification and the amplification of childhood deafness indicate that the attainable realistic goal of EHDI has not yet been achieved. Setting up EHDI through UNHS is a challenge in developing countries, however an unavoidable strategy. Hence cost effective national policies with community support should be considered to give greater chance of linguistic, psychological and social development to the hearing impaired children.
International journal of pediatric otorhinolaryngology, Jan 5, 1999
External laryngotracheal trauma in the paediatric population, although rare, presents a diagnosti... more External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical inter...
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2005
Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evalu... more Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evaluation of patients undergoing endoscopic sinus surgeries (ESS) for chronic rhinosinusitis. The asymmetry of ethmoid fovea olfactory fossa, anatomical variations of lateral lamella and course of anterior ethmoid artery are critical in ESS as it may predispose to dangerous consequences like hemorrhage. CSF leak and intracranial complications. A prospective study was done on 75 patients of clinically and diagnostically proven chronic rhinosimusits. The coronal CT scan was evaluated with special attention to anatomical variations of anterior skull base including ethmoid fovea, olfactory fossa, lateral lamella and course of anterior ethmoid artery. The endoscopic surgeon's awareness of these variations and its role in preventing complications are highlighted.
In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be ... more In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be obscured by extensive mucosal disease or nasal polyposis. Recognition of MSH and its effect on adjacent anatomic structures is of utmost clinical significance in endoscopic sinus surgery. Failure to recognize the impact that MSH has on the position of the ethmoid infundibulum relative to the medial orbital wall could lead to inadvertent damage to the wall during surgery. We conducted a prospective study of 75 patients with clinically and endoscopically proven chronic rhinosinusitis to evaluate the prevalence of MSH. We found that MSH was present in 12 patients (16.0%); 7 of the 75 patients (9.3%) had bilateral disease, and 5 (6.7%) had unilateral disease. We then correlated the relationship of the ethmoid infundibulum to the medial orbital wall as determined by computed tomography in patients with and without MSH. We found that in most cases of MSH, the ethmoid infundibulum was displaced...
Bilateral simultaneous hearing conservation mastoidectomy has not been previously documented. We ... more Bilateral simultaneous hearing conservation mastoidectomy has not been previously documented. We present our experience with this procedure. Three patients with pyogenic meningitis secondary to bilateral unsafe ears had hearing preservation surgeries of both ears in a single sitting. Although ear surgery carries risk of inner ear damage, in our series there was no deterioration of inner ear function in the 6 ears operated on. The air conduction threshold improved in 3 (50%) of the ears. When meningitis results from bilateral otogenic foci as in our series, simultaneous mastoidectomy in both ears may be the preferred method of treatment to eradicate the source of infection.
Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the Eng... more Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the English-language literature. All were bilaterally symmetrical. We present a patient with bilateral asymmetric mucoceles. This patient had a symptomatic mucocele of the right ethmoid sinus with orbital extension and an asymptomatic mucocele involving the left maxillary sinus with retroorbital extension. The latter was an incidental finding on radiologic evaluation. This is the first case report of bilateral mucoceles with asymmetric involvement of the paranasal sinuses.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2003
Auditory neuropathy (AN), a recently described clinical entity, is a sensorineural disorder where... more Auditory neuropathy (AN), a recently described clinical entity, is a sensorineural disorder where the patient has hearing loss with impaired word discrimination out of proportion to pure tone loss in the pressence of abnormal / absent auditory brain stem responses, and normal outer hair cell as measured by otoacoustic emissions and / cochlear microphonics. It is essential that the practicing, ENT surgeon have a high degree of suspicion of AN in patients complaining of difficulty in understanding speech with hearing loss and audiological evidence of dissociation between pure-tone and speech audiometry. Appropriate newer diagnostic tests of ABR and OAE and /or CM for confirmation of AN is essential. We present a series of four patients with auditory neuropathy from a tertiary care teaching hospital. This is the first Series of 4 cases of this clinical entity from the Indian subcontinent.
Allergic rhinitis (AR) is a global health problem and its impact on health related quality of lif... more Allergic rhinitis (AR) is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites (80%) followed by cockroaches (67%). All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues.
Page 1. Saccular Cyst s~ Repiratory distress in neonates with stridor, apparent immediately after... more Page 1. Saccular Cyst s~ Repiratory distress in neonates with stridor, apparent immediately after birth is caused by major airway obstruction like bilateral choanal atresia, bilateral vocal cord paralysis, large saccular cysts or major ...
... Ashish Goel & Shoma V. Rao & Mary S. Mathews &amp... more ... Ashish Goel & Shoma V. Rao & Mary S. Mathews & Alice George & Mary Kurien & Anika Amritanand & Vinodh P. Masilamani & Uday Zachariah & CE Eapen ... 5. Rathi U, Bapat M, Rathi P, Abraham P. Effect of liver disease on maternal and fetal outcome—a prospective study. ...
A 21-year-old nonsmoker, nondiabetic, normotensive man with no family history of coronary artery ... more A 21-year-old nonsmoker, nondiabetic, normotensive man with no family history of coronary artery disease presented with an 8year history of palpitation and progressive angina on exertion. There was no history of pain while at rest. Clinical examination revealed normal systemic blood pressure and bounding peripheral pulses. Systemic examination revealed a hyperdynamic apex with a localized continuous murmur of grade 3/6 in left fourth and fifth intercostal space near the left parasternal region. ECG revealed left ventricular hypertrophy without significant ST-T wave changes.
International Journal of Pediatric Otorhinolaryngology, 2016
To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study i... more To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis. Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system. 152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD-3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media. The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.
Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. ... more Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year. Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our su...
International Journal of Biomedical Research, Jan 30, 2015
The Objectives: To determine the age of suspicion, confirmation and amplification of hearing hand... more The Objectives: To determine the age of suspicion, confirmation and amplification of hearing handicap in children and to assess the burden of parental delay in the evaluation of hearing loss. Methods: A prospective study was done at a tertiary academic hospital in South India on 61 children with bilateral sensory neural deafness who either warrant hearing aid fitting for amplification or those hearing aids found ineffective. Any significant motor, visual, sensory or genetic disorders were excluded. Interviewer administered a questionnaire to the parents, guardian or older children for evaluations of their awareness and knowledge of the special needs. Pure tone audiometry was done for all children older than 5 years and Auditory Brainstem Evoked Response (ABER) audiometry was done in those younger than 5 years and older children who were mentally challenged. All the children were prescribed hearing aid after a trail and those who were already aided were evaluated for the performance of the aid. From the data, the age of suspicion, identification and the amplification were determined. The various factors were noted; data entered and analyzed using Statistical Programme for Social Science (SPSS -Version 6). Design: Prospective case study Results: The mean age in months at first suspicion, identification and the amplification was 19.59 months, 24.82 months and 29.28 months respectively. The average delays between the age of suspicion and identification was 5.23 months and the time interval between the identification and amplification was 4.46 months. In 70.48% of children the hearing loss was suspected after one year of age and only 1.6% have confirmed to have hearing loss and amplified before 6 months. Conclusion: The substantial parental delay of suspicion and its subsequent delay in identification and the amplification of childhood deafness indicate that the attainable realistic goal of EHDI has not yet been achieved. Setting up EHDI through UNHS is a challenge in developing countries, however an unavoidable strategy. Hence cost effective national policies with community support should be considered to give greater chance of linguistic, psychological and social development to the hearing impaired children.
To evaluate the efficacy and safety of intranasal midazolam and chloral hydrate syrup for procedu... more To evaluate the efficacy and safety of intranasal midazolam and chloral hydrate syrup for procedural sedation in children. Prospective randomized placebo-controlled trial (double blind, double dummy). Tertiary care hospital over 18 months. Eighty-two children, 1 to 6 years old, undergoing auditory brainstem response testing were randomized to receive either intranasal midazolam with oral placebo or chloral hydrate syrup with placebo nasal spray. Intranasal midazolam was delivered at 0.5 mg/kg (100 mcg per spray) and oral syrup at 50 mg/kg. Children not sedated at 30 minutes had a second dose at half the initial dose. The primary outcomes measured were safety and efficacy. Secondary outcomes were time to onset of sedation, parental separation, nature of parental separation, parental satisfaction, audiologist's satisfaction, time to recovery, and number of attempts. Forty-one children were in each group, and no major adverse events were noted. The chloral hydrate group showed earlier onset of sedation (66%) compared with the intranasal midazolam group (33%). Significant difference in time to recovery was noted in the chloral hydrate group (78 minutes) versus the intranasal midazolam group (108 minutes). The parents' and audiologist's satisfaction was higher for chloral hydrate (95% and 75%) than for intranasal midazolam (49% and 29%, respectively). Overall, sedation was 95% with chloral hydrate versus 51% with intranasal midazolam. Both drugs maintained sedation. Intranasal midazolam and chloral hydrate are both safe and efficacious for pediatric procedural sedation. Chloral hydrate was superior to intranasal midazolam, with an earlier time to onset of sedation, a faster recovery, better satisfaction among parents and the audiologist, and successful sedation.
International Journal of Biomedical Research, 2015
The Objectives: To determine the age of suspicion, confirmation and amplification of hearing hand... more The Objectives: To determine the age of suspicion, confirmation and amplification of hearing handicap in children and to assess the burden of parental delay in the evaluation of hearing loss. Methods: A prospective study was done at a tertiary academic hospital in South India on 61 children with bilateral sensory neural deafness who either warrant hearing aid fitting for amplification or those hearing aids found ineffective. Any significant motor, visual, sensory or genetic disorders were excluded. Interviewer administered a questionnaire to the parents, guardian or older children for evaluations of their awareness and knowledge of the special needs. Pure tone audiometry was done for all children older than 5 years and Auditory Brainstem Evoked Response (ABER) audiometry was done in those younger than 5 years and older children who were mentally challenged. All the children were prescribed hearing aid after a trail and those who were already aided were evaluated for the performance of the aid. From the data, the age of suspicion, identification and the amplification were determined. The various factors were noted; data entered and analyzed using Statistical Programme for Social Science (SPSS -Version 6). Design: Prospective case study Results: The mean age in months at first suspicion, identification and the amplification was 19.59 months, 24.82 months and 29.28 months respectively. The average delays between the age of suspicion and identification was 5.23 months and the time interval between the identification and amplification was 4.46 months. In 70.48% of children the hearing loss was suspected after one year of age and only 1.6% have confirmed to have hearing loss and amplified before 6 months. Conclusion: The substantial parental delay of suspicion and its subsequent delay in identification and the amplification of childhood deafness indicate that the attainable realistic goal of EHDI has not yet been achieved. Setting up EHDI through UNHS is a challenge in developing countries, however an unavoidable strategy. Hence cost effective national policies with community support should be considered to give greater chance of linguistic, psychological and social development to the hearing impaired children.
International journal of pediatric otorhinolaryngology, Jan 5, 1999
External laryngotracheal trauma in the paediatric population, although rare, presents a diagnosti... more External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical inter...
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2005
Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evalu... more Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evaluation of patients undergoing endoscopic sinus surgeries (ESS) for chronic rhinosinusitis. The asymmetry of ethmoid fovea olfactory fossa, anatomical variations of lateral lamella and course of anterior ethmoid artery are critical in ESS as it may predispose to dangerous consequences like hemorrhage. CSF leak and intracranial complications. A prospective study was done on 75 patients of clinically and diagnostically proven chronic rhinosimusits. The coronal CT scan was evaluated with special attention to anatomical variations of anterior skull base including ethmoid fovea, olfactory fossa, lateral lamella and course of anterior ethmoid artery. The endoscopic surgeon's awareness of these variations and its role in preventing complications are highlighted.
In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be ... more In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be obscured by extensive mucosal disease or nasal polyposis. Recognition of MSH and its effect on adjacent anatomic structures is of utmost clinical significance in endoscopic sinus surgery. Failure to recognize the impact that MSH has on the position of the ethmoid infundibulum relative to the medial orbital wall could lead to inadvertent damage to the wall during surgery. We conducted a prospective study of 75 patients with clinically and endoscopically proven chronic rhinosinusitis to evaluate the prevalence of MSH. We found that MSH was present in 12 patients (16.0%); 7 of the 75 patients (9.3%) had bilateral disease, and 5 (6.7%) had unilateral disease. We then correlated the relationship of the ethmoid infundibulum to the medial orbital wall as determined by computed tomography in patients with and without MSH. We found that in most cases of MSH, the ethmoid infundibulum was displaced...
Bilateral simultaneous hearing conservation mastoidectomy has not been previously documented. We ... more Bilateral simultaneous hearing conservation mastoidectomy has not been previously documented. We present our experience with this procedure. Three patients with pyogenic meningitis secondary to bilateral unsafe ears had hearing preservation surgeries of both ears in a single sitting. Although ear surgery carries risk of inner ear damage, in our series there was no deterioration of inner ear function in the 6 ears operated on. The air conduction threshold improved in 3 (50%) of the ears. When meningitis results from bilateral otogenic foci as in our series, simultaneous mastoidectomy in both ears may be the preferred method of treatment to eradicate the source of infection.
Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the Eng... more Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the English-language literature. All were bilaterally symmetrical. We present a patient with bilateral asymmetric mucoceles. This patient had a symptomatic mucocele of the right ethmoid sinus with orbital extension and an asymptomatic mucocele involving the left maxillary sinus with retroorbital extension. The latter was an incidental finding on radiologic evaluation. This is the first case report of bilateral mucoceles with asymmetric involvement of the paranasal sinuses.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2003
Auditory neuropathy (AN), a recently described clinical entity, is a sensorineural disorder where... more Auditory neuropathy (AN), a recently described clinical entity, is a sensorineural disorder where the patient has hearing loss with impaired word discrimination out of proportion to pure tone loss in the pressence of abnormal / absent auditory brain stem responses, and normal outer hair cell as measured by otoacoustic emissions and / cochlear microphonics. It is essential that the practicing, ENT surgeon have a high degree of suspicion of AN in patients complaining of difficulty in understanding speech with hearing loss and audiological evidence of dissociation between pure-tone and speech audiometry. Appropriate newer diagnostic tests of ABR and OAE and /or CM for confirmation of AN is essential. We present a series of four patients with auditory neuropathy from a tertiary care teaching hospital. This is the first Series of 4 cases of this clinical entity from the Indian subcontinent.
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Papers by Mary Kurien