Mental Health of Frontline Nurses in India During COVID-19: A Multisite Study

Background  The COVID-19 pandemic has been difficult for all healthcare providers. Nurses in Indian hospitals are at risk for mental health consequences of COVID-19-related stress. The study aimed to evaluate the mental health responses of Indian nurses working during the COVID-19 pandemic.  Method The study was carried out during the COVID-19 pandemic from November 2020 to February 2021. Frontline nurses (n=387) working in both government and private sectors were recruited from four hospital centers across Mangalore, India. Nurses were selected based on specific inclusion criteria, including active duty within wards and intensive care units designated for COVID-19 care or suspected cases of SARS-CoV-2 infection. Recruitment and data collection were facilitated by medical residents using a mix of physical and electronic survey methods. Results Nurses within the private sector with low personal protective equipment (PPE) security experienced heightened anxiety. Somatic symptoms were incrementally related to mental health depending on the workplace setting; private sector staff reported greater depression symptoms compared to those in government-run hospitals. Self-efficacy buffered against depression outcomes only in nurses within the private sector working within non-COVID units. Conclusions This study's findings showed differential responses to the stress of COVID-19 based on the setting. Future studies should further explore the factors associated with such differences. Somatic symptoms can be indicators of mental health adversity. Early detection and supportive interventions need to be taken into account.

Assessment of middle ear function after conventional or endoscopic microdebrider assisted adenoidectomy

Objectives

To compare pre- and post-operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic microdebrider assisted adenoidectomy and compare the outcomes.

Methods

Patients diagnosed with chronic adenoiditis were divided in groups of 25 each. Patients in the first group underwent conventional curettage adenoidectomy, while those in second group underwent endoscopic microdebrider assisted adenoidectomy. Pre- and post-operative pure tone and impedance audiometry were performed for all patients and outcomes were compared.

Results

The endoscopic microdebrider assisted method resulted in significantly better outcomes compared to conventional curettage. Criteria such as hearing threshold (p value 0.004 at second follow-up), peak pressure (p value 0.045 at first follow-up) and tympanogram (p value 0.016) showed that the endoscopic method was better, while peak compliance (p value 0.340 at first follow-up) did not show any significant difference between groups.

Conclusions

The endoscopic microdebrider assisted method for adenoidectomy has a definite advantage of better visualisation resulting in better clearance of tissue, leading to enhanced middle ear function compared to conventional curettage.

Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm - A Rare Case

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.

Pediatric Oronasopharyngeal Stricture- A Rare Surgical Complication of Adeno-Tonsillectomy Abstract

Introduction: Oronasopharyngeal stricture is a rare sequel of oropharyngeal surgical procedure which can cause swallowing difficulty, dyspnea, sleep related breathing disorders, incompetence at the velopharynx due to soft palatal adherence. Case: Here we present a case of nine-year-old girl who presented to us with complains of nasal obstruction since 3 months and symptoms of sleep disordered breathing. She underwent adenotonsillectomy 5 years ago and coblator assisted palatoplasty and stricture release 4 months ago. On examination adenoid facies was noted, postpalatoplasty and tonsillectomy status with stricture between the anterior and posterior tonsillar pillars. Soft palate was stuck to posterior pharyngeal wall. Computed tomography scan was done which depicted homogenously enhancing soft tissue density causing complete nasopharyngeal airway obstruction. Oronasopharyngeal stricture release was performed under general anesthesia. Infant feeding tube was inserted through the nasal cavity and introduced through the oropharynx into exterior and was tied externally which was removed on postoperative day 5. Child is on regular follow up since 5 months and asymptomatic. Discussion: Oropharyngeal stricture is reported as a rare sequela of adenotonsillectomy. Many surgical techniques have been reported for release of similar oropharyngeal and nasopharyngeal stricture patterns such as triamcinolone injection, manual dilation method, plasma hook method, division and skin grafting, local flaps like pharyngeal or palatal mucosal flaps, and free flap techniques. Conclusion: Utmost care must be taken during the surgical procedure of oropharynx to prevent collateral damage to mucosal surfaces which can result in such devastating complications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03694-5.

A Rare Case of Submandibular Actinomycosis

Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03498-7.

Modified-modified radical mastoidectomy

PURPOSE

It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case.

CASE PRESENTATION

A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy.

CONCLUSIONS

Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.

Cricopharyngeal Myotomy; a Rescue Surgery for Dysphagia in Lateral Medullary Syndrome

Lateral medullary syndrome/Wallenberg syndrome, is a neurological disorder occurring due to ischemia in the lateral part of medullary oblongata resulting in wide range of symptoms. Dysphagia is usually exhibited in severe and persistent form in LMS. Hence timely intervention is mandatory before the patient further worsens. We describe a case of Lateral medullary syndrome with persisitent dysphagia who was managed successfully with cricopharyngeal myotomy.

Obstructive Sleep Apnoea Syndrome and Association of AHI Scores with Sensorineural Hearing Loss: An Early Predictor

Obstructive sleep apnoea syndrome (OSAS) is a condition that is characterised by frequent apnoea and hypopnoea attacks occurring during sleep. The blood supply to cochlea and acoustic nerves is from terminal arteries, thereby making them susceptible to hypoxia. To compare the audiological profiles in patients with OSAS according to Apnoea Hypopnoea index (AHI) score. Descriptive study was conducted in 32 patients diagnosed to have OSAS in a tertiary referral centre over two year period. The study group was divided into mild, moderate, severe OSAS based on AHI score. The hearing evaluation was done using pure tone audiogram (PTA) and distortion product otoacoustic emission test (DPOAE). Moderate and severe OSAS participants had elevated thresholds at higher frequencies in PTA (4 kHz, 8 kHz), although this was not statistically significant. We also noticed, absent DPOAE responses at higher frequencies (4 k, 6 k, 8 k), with increase in the severity of OSAS at higher frequency, which was statistically significant (p value < 0.05). This study revealed elevated hearing thresholds at higher frequencies (4 kHz, 8 kHz) in PTA and DPOEA with an increase in the severity of OSAS. All OSAS patients, especially with AHI > 30 should be regularly screened for hearing loss.

Unusual Presentation of Otoacariasis: A Prospective Study at Referral Teaching Hospital

Otoacariasis is the presence of ticks and mites within the ear canal. Though the coexistence of ticks and humans is known for thousands of years, tick infestation is relatively rare in urban population. The most common presenting symptoms are usually itching, otalgia and a foreign body sensation and less frequent ones are tinnitus and otorrhoea. We report cases of otoacariasis with unusual presentation. A total of 43 cases presented to the ENT clinic in our hospital over a period of three years from 2018 to 2021. We present patients who presented with unusual symptoms of conductive hearing loss, ear bleed, and facial palsy. Total of 6 cases of otoacariasis had unusual presentation. 2 cases presented with lower motor neuron palsy, 1 case with ear bleed, and 3 cases with hearing loss. Otocariasis can present with unusual symptoms of hearing loss, ear bleed or facial palsy and this should be included in the differential diagnosis of a patient with history of close proximity to domestic or wild animals. Detailed examination often reveals the presence of the tick and identification and complete removal along with appropriate medication for associated symptoms often results in complete recovery.