Rajesh Havaldar - Academia.edu (original) (raw)

Papers by Rajesh Havaldar

Research paper thumbnail of Unraveling the Evolving Trends of Pediatric Tracheostomy- An Overview at a Tertiary Care Center

Acta Scientific Otolaryngology

Research paper thumbnail of Challenges in the management of ENT foreign bodies during COVID-19 Pandemic - Experience at a tertiary care centre

The novel coronavirus disease 2019 (COVID-19) pandemic has put unprecedented challenges on the me... more The novel coronavirus disease 2019 (COVID-19) pandemic has put unprecedented challenges on the medical community. ENT surgical procedures are associated with very high risk of transmission of the virus due to aerosol generation. Management of ENT emergencies due to foreign bodies during ongoing COVID-19 was challenging. This is a prospective study done in our tertiary care centre from March 2020 to June 2020, during COVID-19 pandemic, where patients were referred from primary health facility after unsuccessful attempt. The challenges encountered in the management of these cases, precautions taken and protocols followed are being discussed. The foreign bodies should be removed by trained personnel using Personal Protective Equipment taking all precautions to minimize aerosol generating procedures and limit the length of these procedures whenever possible. Additionally, the use of povidone-iodine in varying concentrations is emphasized in reducing the viral load in the aerodigestive t...

Research paper thumbnail of Test, Track and Treat the Devil in the Paranasal Sinuses

Bengal Journal of Otolaryngology and Head Neck Surgery, 2021

Introduction Complications of rhinosinusitis result from progression of acute fungal or bacterial... more Introduction Complications of rhinosinusitis result from progression of acute fungal or bacterial rhinosinusitis beyond the paranasal sinuses, potentially causing significant morbidity from either local or distant spread. Case Report A 45year old male patient presented with left sided headache since 8 days, left sided facial pain and swelling since 4 days which rapidly progressed to have pre-maxillay pus pointing and cellulitis. Functional endoscopic sinus surgery (FESS) was planned and intraoperatively inferior turbinectomy and maxillary clearance through the necrosed inferior turbinate was performed. Discussion The management of acute fungal rhinosinusitis is surgical debridement by doing FESS. This case report highlights that it may not be the case always. The treatment in the form of maxillary clearance and debridement of necrosed area need to be tailor made according to the disease and involvement as suggested on radiological imaging.

Research paper thumbnail of Effect of Lipid Profile and Serum Creatinine on Hearing Loss in Diabetics

Diabetes mellitus is an endocrine disorder affecting multiple organ systems of which the ear is a... more Diabetes mellitus is an endocrine disorder affecting multiple organ systems of which the ear is also a vulnerable end organ. There is a proposed strong association with the sensorineural part. This study aims to find the prevalence of sensorineural hearing loss in type 2 diabetic patients and additionally assess variations of lipid profile and serum creatinine and its influence on the hearing threshold in type 2 diabetics. A cross-sectional study was conducted with a sample size of 700 at a tertiary care referral hospital over a period of 10 years. They were subjected to a detailed history and ENT examination along with Pure Tone Audiometry and relevant hematological investigations comprising of HbA1c, blood urea, and serum creatinine. Urine analysis to look for microalbuminuria was performed. Sensorineural hearing loss in type II diabetics was found to be 62.85%. The total cholesterol levels were also found to be raised in hearing deprived patients. HDL and LDL levels were found to have a negligible effect on the hearing threshold. The serum creatinine levels were higher in patients with diabetes implicating an association with nephropathy. Microalbuminuria was found in nearly all patients with moderately severe to profound hearing loss. The results were statistically significant. It has been observed that short term sugar control is found to have a negligible effect over the sensorineural hearing than the long term sugar control which severely affects the neural component, as depicted by the lipid and creatinine levels in our study.

Research paper thumbnail of Unusual Foreign Body in Aerodigestive Tract- a Difficult Diagnosis during a Pandemic

Journal of Allergy and Therapy, 2020

Foreign body in aerodigestive tract is not an uncommon condition especially in paediatric age gro... more Foreign body in aerodigestive tract is not an uncommon condition especially in paediatric age group. However in adults it is usually seen most commonly in psychiatric patients or mentally disabled individual. We present a case of accidental foreign body ingestion in an adult male. The case report highlights the importance of using the right investigation to detect the foreign body thereby aiding in proper management to prevent morbidity and mortality.

Research paper thumbnail of Benefits and challenges associated with the timing of tracheostomy in critically ill patients: experience at a tertiary intensive care unit

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tr... more Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tracheostomy is performed with an aim to facilitate pulmonary toileting and also protect the upper airways from the associated ill effects of prolonged endotracheal intubation. The timing of this procedure is a matter of considerable debate and varies according to different centres.Methods: 50 patients were assessed. 34 belonged to the early group and 16 belonged to the late group. The study was carried out in the ICU of a tertiary care referral centre. The timing of occurrence of ventilator associated pneumonia (VAP), duration of ICU stay and duration of tracheostomy and the was compared between the early and late groups respectively.Results: It was found that early tracheostomy leads to reduced ICU stay and delayed occurrence of VAP. The results were statistically significant. Additionally, it was also observed in this study that early tracheostomy leads to reduced duration of tracheosto...

Research paper thumbnail of Subjective and Objective Outcome Assessment in Patients with Sinonasal Disease After Microdebrider Assisted Endoscopic Sinus Surgery

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suc... more Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suction. The present study aims to assess the subjective and objective outcome in patients with sinonasal disease after microdebrider assisted endoscopic sinus surgery. A prospective observational study was carried out among 40 patients with symptoms suggestive of sinonasal diseases willing to undergo microdebrider assisted sinus surgery at our tertiary care hospital from January 2019 to December 2019. All the patients underwent microdebrider assisted endoscopic sinus surgery (ESS). Patients were subjectively evaluated using the Lund and Mackay staging system using visual analogue score and objectively using nasal endoscopy by the Lund and Kennedy scoring system preoperatively and post operatively after 6 weeks. 40 patients were included in the study. A mean age of 37 years were noted. All patients showed significant statistical improvement in Lund Mackay scoring system by visual analogue scoring and Lund Kennedy endoscopic scoring postoperatively. Thus, microdebrider offers a better therapeutic approach for patients with sinonasal diseases when compared to endoscopic surgery with the conventional instruments. The advantage of using microdebrider in ESS remains to be proper removal of the pathology, good surgical field and better postoperative outcome.

Research paper thumbnail of Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The use of microdebrider in various sinonasal diseases have been sparingly understood... more Background: The use of microdebrider in various sinonasal diseases have been sparingly understood. The present study aims to find out the effectiveness of a microdebrider in different sinonasal diseases by using each domain of visual analogue scale (VAS) and confirming the findings by diagnostic nasal endoscopy.Methods: A prospective observational study was done among patients with sinonasal disease between January 2019 to March 2020 in our tertiary care hospital. A subjective visual analogue scale (VAS) was completed by every patient for all domains according to Lund and Mackay symptom scoring system. Using Lund Kennedy scoring, polyp, edema and discharge were assessed preoperatively. Patients were followed up for 1 week, 6 weeks and 3 months. At 3 months both VAS and Lund Kennedy scoring was done. Post operatively scarring and crusting were assessed separately.Results: There was a significant improvement in domains post operatively in all the diseases considered (p=0.001). In Lund...

Research paper thumbnail of Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The use of microdebrider in various sinonasal diseases have been sparingly understood... more Background: The use of microdebrider in various sinonasal diseases have been sparingly understood. The present study aims to find out the effectiveness of a microdebrider in different sinonasal diseases by using each domain of visual analogue scale (VAS) and confirming the findings by diagnostic nasal endoscopy.Methods: A prospective observational study was done among patients with sinonasal disease between January 2019 to March 2020 in our tertiary care hospital. A subjective visual analogue scale (VAS) was completed by every patient for all domains according to Lund and Mackay symptom scoring system. Using Lund Kennedy scoring, polyp, edema and discharge were assessed preoperatively. Patients were followed up for 1 week, 6 weeks and 3 months. At 3 months both VAS and Lund Kennedy scoring was done. Post operatively scarring and crusting were assessed separately.Results: There was a significant improvement in domains post operatively in all the diseases considered (p=0.001). In Lund...

Research paper thumbnail of Evaluation of graft uptake using temporalis fascia and cartilage perichondrium supplemented with autologous platelet rich plasma in tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materia... more Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materials such as temporalis fascia, cartilage perichondrium, periosteum, vein, fat etc. Both temporalis fascia and cartilage perichondrium are easy to harvest with minimum donor site complications and both have been used extensively in tympanoplasty. Platelet rich plasma aids as an adhesive and supplements healing by providing growth factors. Till date there is scarcity of literature comparing the healing outcome of both cartilage perichondrium and temporalis fascia supplemented with platelet rich plasma. Hence, in this study we are comparing cartilage perichondrium supplemented with platelet rich plasma and temporalis fascia supplemented with platelet rich plasma. Methods: An observational study involving 60 patients was done. Patients with chronic otitis media were evaluated by otoendoscopy to assess the ear and were categorised into 2 groups which received temporalis fascia and cartilage p...

Research paper thumbnail of Study of Efficacy of Intraoral Submucosal Injections of Corticosteroids and Placentrex in the Management of Oral Submucous Fibrosis

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Research paper thumbnail of Correlation Between Allergic Rhinitis and Body Mass Index: An Observational Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Allergic rhinitis is one of the most rampant diseases in the world and many studies have been con... more Allergic rhinitis is one of the most rampant diseases in the world and many studies have been conducted to find its risk factors. Various studies have shown that there is a correlation between allergic rhinitis and increased Body Mass Index (BMI). Obesity has several effects on the immune system that could play a major role in increasing allergic disease. Allergic rhinitis is known to produce mild eosinophilia. The purpose of this study is to assess the correlation between BMI and allergic rhinitis using the Absolute Eosinophil Count (AEC). Over a period of 6 months, 55 cases of allergic rhinitis were selected. The patients were investigated by Absolute Eosinophil Count and their Body Mass Index values were calculated based on weight and height measurement. There was a positive correlation between Absolute Eosinophil Count and BMI with a p value of \ 0.0001 which in turn revealed a positive correlation between BMI and allergy. We conclude that patients with high BMI are more prone to allergic rhinitis and have higher Absolute Eosinophil Counts probably due to the immunological effects of adipose tissue on the progress of the allergic disease.

Research paper thumbnail of Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associate... more Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in posttonsillectomy analgesia. Over a period of 1 year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24 h post operatively. Using Mann-Whitney nonparametric statistical test, inter-group analysis was done which showed highly significant p-value (\0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Research paper thumbnail of Post Mastoidectomy Delayed Facial Nerve Palsy – a Surgeon’s Short-Lived Nightmare!!

British Journal of Medical and Health Research, 2020

Post mastoidectomy facial nerve palsy is seen either immediately or after some delay following su... more Post mastoidectomy facial nerve palsy is seen either immediately or after some delay following surgery. Early diagnosis and treatment is key to prevent fatal complications. Methodology: A set of 3 case series was studied who developed facial palsy after 7 to10 days of uneventful mastoid surgery. Serial photographs were taken to document the progression of the patients from disease to recovery after instillation of therapy. Results-All 3 patients completely recovered within 30 days. Conclusion: Delayed facial nerve palsy is rare. It can be due to virus reactivation, surgical stress, or laceration of the chorda tympani nerve with a resultant retrograde facial nerve edema. But with timely presentation & management, it has a good prognosis and recovery rate. A combined approach from the Otolaryngologist and the Physiotherapist aids in the timely improvement of the patient.

Research paper thumbnail of Correlative Multicentric Analysis of Dimensions of Nasopharynx and Adenoid Size, and its Burden in Otitis Media with Effusion: An Indian Scenario

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the m... more Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the middle ear cleft. It has been demonstrated both by radiological techniques and middle ear pressure studies that adenoids can and do obstruct the Eustachian Tube. The Adenoid-Nasopharyngeal Ratio (ANR), can offer a simple arithmetic measure of nasopharyngeal obstruction. Coupled with tympanometry, it also predicts the degree to which the middle ear is affected. Multicentric study done at two centres in India. 230 patients were studied. Children were in the age group of 5-14 years. The nasopharyngeal and adenoid dimensions were measured separately using the Fujioka method. The adenoid-nasopharyngeal ratio was derived by the arithmetic method. All patients were also subjected to tympanometry. ANR decreased from 0.728 to 0.663 with an increase in age from 5 to 12 years. ANR between 0.701-0.800 had maximum number of Type B (140) and Type C (71) Tympanogram whereas between 0.801 and 0.900, all Tympanogram were found to be of Type B or Type C with none belonging to Type A. Using ANR and Tympanometry, the effects of the adenoids on the middle ear can be quantified indirectly. Both these modalities are easily available, economical, safe and can be performed at the Out Patient Level. This aids in timely and appropriate management thus preventing discomforting symptoms caused by the adenoids locally and also the morbidity caused to the middle ear in the long term.

Research paper thumbnail of An Interesting Case of a Butcher Who Attempted to Cut His Neck

Bengal Journal of Otolaryngology and Head Neck Surgery, 2018

Introduction Cut throat injuries are well recognized in homicide but less recognized in suicides.... more Introduction Cut throat injuries are well recognized in homicide but less recognized in suicides. The incidence of suicide is increasing worldwide owing to the more stressful strenuous lifestyle and other risk factors like substance abuse. Suicide by incising one’s own throat is associated with hesitation marks whereas homicidal wounds are not. Case Report We present an interesting case of a suicidal cut throat of the victim being a butcher who was on alcohol abstinence since 3 days with severe injuries of supraglottic larynx and cricopharynx, surprisingly without any evidence of hesitation marks. He underwent immediate neck exploration and suturing of the injured structures without the need of a tracheostomy. Discussion A multidisciplinary approach by Otolaryngologists, Psychiatrists, Intensivists, and Anaesthetists is required in the effective management of these victims. A thorough proper early assessment can totally avoid the need of tracheostomy which is recommended in practice...

Research paper thumbnail of A Prospective Study Assessing the Audiological Outcome of Tympanoplasty with Autologus Platelet Rich Plasma

Biomedical Journal of Scientific & Technical Research, 2021

A prospective observational study in 90 patients of age group of 15 to 50 years with chronic supp... more A prospective observational study in 90 patients of age group of 15 to 50 years with chronic suppurative otitis media attending the outpatient department of ENT at a tertiary care referral centre was conducted. All patients during the study period underwent Tympanoplasty with Platelet Rich Plasma for assessing the hearing gain. The objective of this study was to assess the benefits of platelet rich plasma in terms of improvement in hearing after tympanoplasty. In this prospective observational study using autologous Platelet Rich Plasma; patients showed a significant audiological hearing improvement at 3 months postoperative period compared to preoperative audiological assessment. Thus, we can conclude that Tympanoplasty not only aims to correct the damaged tympanic membrane, but also aids in improvement in hearing by reducing the amount of conductive hearing loss. The use of Autologous Platelet rich plasma helps in adequate sealing of the graft material along with the freshened edges of the perforation, thereby accelerating the graft uptake, promoting faster healing and hearing improvement.

Research paper thumbnail of Hearing Impairment and its Associated Causes among Children below 5 year Age Group using Brainstem Evoked Response Audiometry

Madridge Journal of Otorhinolaryngology, 2018

Research paper thumbnail of Acute necrotizing otitis media in infant: a rare and challenging case

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020

Acute necrotizing otitis media (ANOM) is a highly virulent middle ear infection that results in n... more Acute necrotizing otitis media (ANOM) is a highly virulent middle ear infection that results in necrosis of the tympanic cavity. Here a rare case report is presented of a 4 month infant who presented with bilateral ANOM and right facial nerve palsy which was aggressively managed with debridement and intravenous antibiotics obviating the need of surgery. The child was followed up for a period of 6 months where both the ears remained disease free accompanied with hearing gain and grade of facial palsy improvement from grade V to grade II. ANOM is still a possibility in the modern era of higher antibiotics and a high index of suspicion is required. Timely and aggressive management has to be done in order to prevent the dreaded complications and sequelae like facial nerve palsy and hearing loss which are likely to be permanent.

Research paper thumbnail of Evaluation of graft uptake using temporalis fascia and cartilage perichondrium supplemented with autologous platelet rich plasma in tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materia... more Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materials such as temporalis fascia, cartilage perichondrium, periosteum, vein, fat etc. Both temporalis fascia and cartilage perichondrium are easy to harvest with minimum donor site complications and both have been used extensively in tympanoplasty. Platelet rich plasma aids as an adhesive and supplements healing by providing growth factors. Till date there is scarcity of literature comparing the healing outcome of both cartilage perichondrium and temporalis fascia supplemented with platelet rich plasma. Hence, in this study we are comparing cartilage perichondrium supplemented with platelet rich plasma and temporalis fascia supplemented with platelet rich plasma. Methods: An observational study involving 60 patients was done. Patients with chronic otitis media were evaluated by otoendoscopy to assess the ear and were categorised into 2 groups which received temporalis fascia and cartilage p...

Research paper thumbnail of Unraveling the Evolving Trends of Pediatric Tracheostomy- An Overview at a Tertiary Care Center

Acta Scientific Otolaryngology

Research paper thumbnail of Challenges in the management of ENT foreign bodies during COVID-19 Pandemic - Experience at a tertiary care centre

The novel coronavirus disease 2019 (COVID-19) pandemic has put unprecedented challenges on the me... more The novel coronavirus disease 2019 (COVID-19) pandemic has put unprecedented challenges on the medical community. ENT surgical procedures are associated with very high risk of transmission of the virus due to aerosol generation. Management of ENT emergencies due to foreign bodies during ongoing COVID-19 was challenging. This is a prospective study done in our tertiary care centre from March 2020 to June 2020, during COVID-19 pandemic, where patients were referred from primary health facility after unsuccessful attempt. The challenges encountered in the management of these cases, precautions taken and protocols followed are being discussed. The foreign bodies should be removed by trained personnel using Personal Protective Equipment taking all precautions to minimize aerosol generating procedures and limit the length of these procedures whenever possible. Additionally, the use of povidone-iodine in varying concentrations is emphasized in reducing the viral load in the aerodigestive t...

Research paper thumbnail of Test, Track and Treat the Devil in the Paranasal Sinuses

Bengal Journal of Otolaryngology and Head Neck Surgery, 2021

Introduction Complications of rhinosinusitis result from progression of acute fungal or bacterial... more Introduction Complications of rhinosinusitis result from progression of acute fungal or bacterial rhinosinusitis beyond the paranasal sinuses, potentially causing significant morbidity from either local or distant spread. Case Report A 45year old male patient presented with left sided headache since 8 days, left sided facial pain and swelling since 4 days which rapidly progressed to have pre-maxillay pus pointing and cellulitis. Functional endoscopic sinus surgery (FESS) was planned and intraoperatively inferior turbinectomy and maxillary clearance through the necrosed inferior turbinate was performed. Discussion The management of acute fungal rhinosinusitis is surgical debridement by doing FESS. This case report highlights that it may not be the case always. The treatment in the form of maxillary clearance and debridement of necrosed area need to be tailor made according to the disease and involvement as suggested on radiological imaging.

Research paper thumbnail of Effect of Lipid Profile and Serum Creatinine on Hearing Loss in Diabetics

Diabetes mellitus is an endocrine disorder affecting multiple organ systems of which the ear is a... more Diabetes mellitus is an endocrine disorder affecting multiple organ systems of which the ear is also a vulnerable end organ. There is a proposed strong association with the sensorineural part. This study aims to find the prevalence of sensorineural hearing loss in type 2 diabetic patients and additionally assess variations of lipid profile and serum creatinine and its influence on the hearing threshold in type 2 diabetics. A cross-sectional study was conducted with a sample size of 700 at a tertiary care referral hospital over a period of 10 years. They were subjected to a detailed history and ENT examination along with Pure Tone Audiometry and relevant hematological investigations comprising of HbA1c, blood urea, and serum creatinine. Urine analysis to look for microalbuminuria was performed. Sensorineural hearing loss in type II diabetics was found to be 62.85%. The total cholesterol levels were also found to be raised in hearing deprived patients. HDL and LDL levels were found to have a negligible effect on the hearing threshold. The serum creatinine levels were higher in patients with diabetes implicating an association with nephropathy. Microalbuminuria was found in nearly all patients with moderately severe to profound hearing loss. The results were statistically significant. It has been observed that short term sugar control is found to have a negligible effect over the sensorineural hearing than the long term sugar control which severely affects the neural component, as depicted by the lipid and creatinine levels in our study.

Research paper thumbnail of Unusual Foreign Body in Aerodigestive Tract- a Difficult Diagnosis during a Pandemic

Journal of Allergy and Therapy, 2020

Foreign body in aerodigestive tract is not an uncommon condition especially in paediatric age gro... more Foreign body in aerodigestive tract is not an uncommon condition especially in paediatric age group. However in adults it is usually seen most commonly in psychiatric patients or mentally disabled individual. We present a case of accidental foreign body ingestion in an adult male. The case report highlights the importance of using the right investigation to detect the foreign body thereby aiding in proper management to prevent morbidity and mortality.

Research paper thumbnail of Benefits and challenges associated with the timing of tracheostomy in critically ill patients: experience at a tertiary intensive care unit

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tr... more Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tracheostomy is performed with an aim to facilitate pulmonary toileting and also protect the upper airways from the associated ill effects of prolonged endotracheal intubation. The timing of this procedure is a matter of considerable debate and varies according to different centres.Methods: 50 patients were assessed. 34 belonged to the early group and 16 belonged to the late group. The study was carried out in the ICU of a tertiary care referral centre. The timing of occurrence of ventilator associated pneumonia (VAP), duration of ICU stay and duration of tracheostomy and the was compared between the early and late groups respectively.Results: It was found that early tracheostomy leads to reduced ICU stay and delayed occurrence of VAP. The results were statistically significant. Additionally, it was also observed in this study that early tracheostomy leads to reduced duration of tracheosto...

Research paper thumbnail of Subjective and Objective Outcome Assessment in Patients with Sinonasal Disease After Microdebrider Assisted Endoscopic Sinus Surgery

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suc... more Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suction. The present study aims to assess the subjective and objective outcome in patients with sinonasal disease after microdebrider assisted endoscopic sinus surgery. A prospective observational study was carried out among 40 patients with symptoms suggestive of sinonasal diseases willing to undergo microdebrider assisted sinus surgery at our tertiary care hospital from January 2019 to December 2019. All the patients underwent microdebrider assisted endoscopic sinus surgery (ESS). Patients were subjectively evaluated using the Lund and Mackay staging system using visual analogue score and objectively using nasal endoscopy by the Lund and Kennedy scoring system preoperatively and post operatively after 6 weeks. 40 patients were included in the study. A mean age of 37 years were noted. All patients showed significant statistical improvement in Lund Mackay scoring system by visual analogue scoring and Lund Kennedy endoscopic scoring postoperatively. Thus, microdebrider offers a better therapeutic approach for patients with sinonasal diseases when compared to endoscopic surgery with the conventional instruments. The advantage of using microdebrider in ESS remains to be proper removal of the pathology, good surgical field and better postoperative outcome.

Research paper thumbnail of Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The use of microdebrider in various sinonasal diseases have been sparingly understood... more Background: The use of microdebrider in various sinonasal diseases have been sparingly understood. The present study aims to find out the effectiveness of a microdebrider in different sinonasal diseases by using each domain of visual analogue scale (VAS) and confirming the findings by diagnostic nasal endoscopy.Methods: A prospective observational study was done among patients with sinonasal disease between January 2019 to March 2020 in our tertiary care hospital. A subjective visual analogue scale (VAS) was completed by every patient for all domains according to Lund and Mackay symptom scoring system. Using Lund Kennedy scoring, polyp, edema and discharge were assessed preoperatively. Patients were followed up for 1 week, 6 weeks and 3 months. At 3 months both VAS and Lund Kennedy scoring was done. Post operatively scarring and crusting were assessed separately.Results: There was a significant improvement in domains post operatively in all the diseases considered (p=0.001). In Lund...

Research paper thumbnail of Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The use of microdebrider in various sinonasal diseases have been sparingly understood... more Background: The use of microdebrider in various sinonasal diseases have been sparingly understood. The present study aims to find out the effectiveness of a microdebrider in different sinonasal diseases by using each domain of visual analogue scale (VAS) and confirming the findings by diagnostic nasal endoscopy.Methods: A prospective observational study was done among patients with sinonasal disease between January 2019 to March 2020 in our tertiary care hospital. A subjective visual analogue scale (VAS) was completed by every patient for all domains according to Lund and Mackay symptom scoring system. Using Lund Kennedy scoring, polyp, edema and discharge were assessed preoperatively. Patients were followed up for 1 week, 6 weeks and 3 months. At 3 months both VAS and Lund Kennedy scoring was done. Post operatively scarring and crusting were assessed separately.Results: There was a significant improvement in domains post operatively in all the diseases considered (p=0.001). In Lund...

Research paper thumbnail of Evaluation of graft uptake using temporalis fascia and cartilage perichondrium supplemented with autologous platelet rich plasma in tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materia... more Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materials such as temporalis fascia, cartilage perichondrium, periosteum, vein, fat etc. Both temporalis fascia and cartilage perichondrium are easy to harvest with minimum donor site complications and both have been used extensively in tympanoplasty. Platelet rich plasma aids as an adhesive and supplements healing by providing growth factors. Till date there is scarcity of literature comparing the healing outcome of both cartilage perichondrium and temporalis fascia supplemented with platelet rich plasma. Hence, in this study we are comparing cartilage perichondrium supplemented with platelet rich plasma and temporalis fascia supplemented with platelet rich plasma. Methods: An observational study involving 60 patients was done. Patients with chronic otitis media were evaluated by otoendoscopy to assess the ear and were categorised into 2 groups which received temporalis fascia and cartilage p...

Research paper thumbnail of Study of Efficacy of Intraoral Submucosal Injections of Corticosteroids and Placentrex in the Management of Oral Submucous Fibrosis

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Research paper thumbnail of Correlation Between Allergic Rhinitis and Body Mass Index: An Observational Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Allergic rhinitis is one of the most rampant diseases in the world and many studies have been con... more Allergic rhinitis is one of the most rampant diseases in the world and many studies have been conducted to find its risk factors. Various studies have shown that there is a correlation between allergic rhinitis and increased Body Mass Index (BMI). Obesity has several effects on the immune system that could play a major role in increasing allergic disease. Allergic rhinitis is known to produce mild eosinophilia. The purpose of this study is to assess the correlation between BMI and allergic rhinitis using the Absolute Eosinophil Count (AEC). Over a period of 6 months, 55 cases of allergic rhinitis were selected. The patients were investigated by Absolute Eosinophil Count and their Body Mass Index values were calculated based on weight and height measurement. There was a positive correlation between Absolute Eosinophil Count and BMI with a p value of \ 0.0001 which in turn revealed a positive correlation between BMI and allergy. We conclude that patients with high BMI are more prone to allergic rhinitis and have higher Absolute Eosinophil Counts probably due to the immunological effects of adipose tissue on the progress of the allergic disease.

Research paper thumbnail of Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associate... more Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in posttonsillectomy analgesia. Over a period of 1 year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24 h post operatively. Using Mann-Whitney nonparametric statistical test, inter-group analysis was done which showed highly significant p-value (\0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Research paper thumbnail of Post Mastoidectomy Delayed Facial Nerve Palsy – a Surgeon’s Short-Lived Nightmare!!

British Journal of Medical and Health Research, 2020

Post mastoidectomy facial nerve palsy is seen either immediately or after some delay following su... more Post mastoidectomy facial nerve palsy is seen either immediately or after some delay following surgery. Early diagnosis and treatment is key to prevent fatal complications. Methodology: A set of 3 case series was studied who developed facial palsy after 7 to10 days of uneventful mastoid surgery. Serial photographs were taken to document the progression of the patients from disease to recovery after instillation of therapy. Results-All 3 patients completely recovered within 30 days. Conclusion: Delayed facial nerve palsy is rare. It can be due to virus reactivation, surgical stress, or laceration of the chorda tympani nerve with a resultant retrograde facial nerve edema. But with timely presentation & management, it has a good prognosis and recovery rate. A combined approach from the Otolaryngologist and the Physiotherapist aids in the timely improvement of the patient.

Research paper thumbnail of Correlative Multicentric Analysis of Dimensions of Nasopharynx and Adenoid Size, and its Burden in Otitis Media with Effusion: An Indian Scenario

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the m... more Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the middle ear cleft. It has been demonstrated both by radiological techniques and middle ear pressure studies that adenoids can and do obstruct the Eustachian Tube. The Adenoid-Nasopharyngeal Ratio (ANR), can offer a simple arithmetic measure of nasopharyngeal obstruction. Coupled with tympanometry, it also predicts the degree to which the middle ear is affected. Multicentric study done at two centres in India. 230 patients were studied. Children were in the age group of 5-14 years. The nasopharyngeal and adenoid dimensions were measured separately using the Fujioka method. The adenoid-nasopharyngeal ratio was derived by the arithmetic method. All patients were also subjected to tympanometry. ANR decreased from 0.728 to 0.663 with an increase in age from 5 to 12 years. ANR between 0.701-0.800 had maximum number of Type B (140) and Type C (71) Tympanogram whereas between 0.801 and 0.900, all Tympanogram were found to be of Type B or Type C with none belonging to Type A. Using ANR and Tympanometry, the effects of the adenoids on the middle ear can be quantified indirectly. Both these modalities are easily available, economical, safe and can be performed at the Out Patient Level. This aids in timely and appropriate management thus preventing discomforting symptoms caused by the adenoids locally and also the morbidity caused to the middle ear in the long term.

Research paper thumbnail of An Interesting Case of a Butcher Who Attempted to Cut His Neck

Bengal Journal of Otolaryngology and Head Neck Surgery, 2018

Introduction Cut throat injuries are well recognized in homicide but less recognized in suicides.... more Introduction Cut throat injuries are well recognized in homicide but less recognized in suicides. The incidence of suicide is increasing worldwide owing to the more stressful strenuous lifestyle and other risk factors like substance abuse. Suicide by incising one’s own throat is associated with hesitation marks whereas homicidal wounds are not. Case Report We present an interesting case of a suicidal cut throat of the victim being a butcher who was on alcohol abstinence since 3 days with severe injuries of supraglottic larynx and cricopharynx, surprisingly without any evidence of hesitation marks. He underwent immediate neck exploration and suturing of the injured structures without the need of a tracheostomy. Discussion A multidisciplinary approach by Otolaryngologists, Psychiatrists, Intensivists, and Anaesthetists is required in the effective management of these victims. A thorough proper early assessment can totally avoid the need of tracheostomy which is recommended in practice...

Research paper thumbnail of A Prospective Study Assessing the Audiological Outcome of Tympanoplasty with Autologus Platelet Rich Plasma

Biomedical Journal of Scientific & Technical Research, 2021

A prospective observational study in 90 patients of age group of 15 to 50 years with chronic supp... more A prospective observational study in 90 patients of age group of 15 to 50 years with chronic suppurative otitis media attending the outpatient department of ENT at a tertiary care referral centre was conducted. All patients during the study period underwent Tympanoplasty with Platelet Rich Plasma for assessing the hearing gain. The objective of this study was to assess the benefits of platelet rich plasma in terms of improvement in hearing after tympanoplasty. In this prospective observational study using autologous Platelet Rich Plasma; patients showed a significant audiological hearing improvement at 3 months postoperative period compared to preoperative audiological assessment. Thus, we can conclude that Tympanoplasty not only aims to correct the damaged tympanic membrane, but also aids in improvement in hearing by reducing the amount of conductive hearing loss. The use of Autologous Platelet rich plasma helps in adequate sealing of the graft material along with the freshened edges of the perforation, thereby accelerating the graft uptake, promoting faster healing and hearing improvement.

Research paper thumbnail of Hearing Impairment and its Associated Causes among Children below 5 year Age Group using Brainstem Evoked Response Audiometry

Madridge Journal of Otorhinolaryngology, 2018

Research paper thumbnail of Acute necrotizing otitis media in infant: a rare and challenging case

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020

Acute necrotizing otitis media (ANOM) is a highly virulent middle ear infection that results in n... more Acute necrotizing otitis media (ANOM) is a highly virulent middle ear infection that results in necrosis of the tympanic cavity. Here a rare case report is presented of a 4 month infant who presented with bilateral ANOM and right facial nerve palsy which was aggressively managed with debridement and intravenous antibiotics obviating the need of surgery. The child was followed up for a period of 6 months where both the ears remained disease free accompanied with hearing gain and grade of facial palsy improvement from grade V to grade II. ANOM is still a possibility in the modern era of higher antibiotics and a high index of suspicion is required. Timely and aggressive management has to be done in order to prevent the dreaded complications and sequelae like facial nerve palsy and hearing loss which are likely to be permanent.

Research paper thumbnail of Evaluation of graft uptake using temporalis fascia and cartilage perichondrium supplemented with autologous platelet rich plasma in tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materia... more Background: Tympanoplasty involves grafting the perforation of the tympanic membrane with materials such as temporalis fascia, cartilage perichondrium, periosteum, vein, fat etc. Both temporalis fascia and cartilage perichondrium are easy to harvest with minimum donor site complications and both have been used extensively in tympanoplasty. Platelet rich plasma aids as an adhesive and supplements healing by providing growth factors. Till date there is scarcity of literature comparing the healing outcome of both cartilage perichondrium and temporalis fascia supplemented with platelet rich plasma. Hence, in this study we are comparing cartilage perichondrium supplemented with platelet rich plasma and temporalis fascia supplemented with platelet rich plasma. Methods: An observational study involving 60 patients was done. Patients with chronic otitis media were evaluated by otoendoscopy to assess the ear and were categorised into 2 groups which received temporalis fascia and cartilage p...