Etiology and treatment modalities in epistaxis

<p><strong>Background:</strong> Epistaxis or 'hemorrhage from the nose' is a frequent presentation in the otorhinolaryngologic emergency and both conservative and surgical modalities have been used in the treatment. The present study was undertaken to estimate the proportion of patients with epistaxis who are effectively managed with conservative modalities.</p><p class="abstract"><strong>Methods:</strong> A total of 60 patients (39 males and 21 females) between 18 and 70 years, with epistaxis were studied in the department of otorhinolaryngology and emergency units of Dr. Somervell Memorial C.S.I Medical College Hospital, Karakonam, Thiruvananthapuram, between November 2018 and April 2020. The data, that is the proportion of patients who are effectively managed with conservative modalities, was entered into Microsoft - Excel sheet and analysis was done using statistical package for social sciences (SPSS) software trial version.</p><p class="abstract"><strong>Results: </strong>Out of 60 cases of epistaxis, 81.67% were effectively controlled by conservative management like general first aid (43.33%), chemical cautery (10%), and nasal packings via anterior (21.67%) and posterior (6.67%).</p><p class="abstract"><strong>Conclusions:</strong> In 81.67% nasal bleeding was effectively controlled by conservative treatment measures and in 18.33% surgical measures were required. </p>

A STUDY OF ETIOPATHOGENESIS OF MIDDLE EAR GRANULATIONS IN CHRONIC OTITIS MEDIAAND THEIR MANAGEMENT

Objective: The purpose of this study was to evaluate the etiopathogenesis of middle ear granulations in cases of Chronic Otitis Media (COM) and their management. Materials and Methods:Aprospective study was conducted on 100 patients over a period of 12 months. Patients clinically diagnosed as COM and operated, with the ndings of granulations in middle ear were included in this study. Each of these patients was subjected to complete history and thorough ENT examination after taking proper written informed consent. Clinical and laboratory data from the study was recorded as per the proforma. Results:Analysis of data revealed that maximum cases were found in the second or third decade of life with a male preponderance. Rural patients were 75% as compared to those from urban background 25%. Mucosal type of COM was found in 69% patients and squamous type in 31% patients. Maximum patients presented with history of discharge since 5-10 years, mostly mucopurulent type of discharge. Granulations were found to be present at more that one site in middle ear in most of the patients. Incus was the most commonly involved ossicle. Conservative management included chemical cautery and aural toilet followed with antibiotics with topical steroid.

Treatment of tympanic membrane perforation with topical epidermal growth factor: progress towards clinical application

<p class="abstract"><strong>Background:</strong> Chronic otitis media is a widespread disease of developing countries, especially of the lower socio-economic group. Medical cost in hospitals associated with tympanoplasty for treating CSOM is very high. Our study investigates the efficacy of epidermal growth factor along with chemical cautery in healing of chronic tympanic membrane perforation on an outpatient department (OPD) basis. Hence providing a cheaper and cost effective treatment alternative to the patients.</p><p class="abstract"><strong>Methods:</strong> A total number of 70 patients with signs of COM attending ENT OPD were selected. The patients were randomly assigned into 2 groups each with a sample size of 35. Otoendoscopy and pure tone audiometry was performed. Group A was treated with EGF with chemical cautery and group B was treated with only chemical cautery. Both groups were followed up after 15 days, one month and second month of the procedure in ENT outpatient clinic.</p><p class="abstract"><strong>Results:</strong> The success rate of these non-healing perforation was found to be significantly higher in group A (29 [82.86%]) compared with group B (17 [65.71%]) with P value of 0.0070*.</p><p class="abstract"><strong>Conclusions: </strong>This study shows a statistically significant result with topical application of epidermal growth factor in small to medium non-healing central tympanic membrane perforation. Due to the promising result of epidermal growth factor, it could be considered as office myringoplasty. </p>

Epistaxis: comparison of chemical cautery with topical vasoconstrictor in adult anterior epistaxis

Background: To compare efficacy of 75% silver nitrate chemical cautery as opposed to topical vasoconstrictor spray (xylometazoline 0.1%) in adult anterior epistaxis.Methods: This randomized controlled trial study was carried out at SMHS Hospital Srinagar from Jan 2019 to Dec 2019. 110 subjects that presented to ENT & HNS emergency with epistaxis and fulfilled the inclusion criteria were selected. Subjects were randomly distributed into two groups. Group-A individuals were treated by cauterization with 75% silver nitrate and Group-B individuals were treated with topical vasoconstrictor spray (xylometazoline 0.1%). All the subjects were reviewed at 1 month and success was determined in terms of control of epistaxis from same side of nose.Results: The mean age of the cohort was 48.5yrs (age range, 17-59). There were total 60 (54.4%) males and 50 (45.4%) females among the cases. Both the groups were comparable as regards the age, sex, duration and frequency of epistaxis. 91.2% cases in Group-A (silver nitrate cautery) and 73.5% cases in Group-B (xylometazoline spray 0.1%) had no further epistaxis at one-month follow-up (p=0.014).Conclusions: Chemical cauterization with silver nitrate is a feasible and safe technique for the treatment of adult anterior epistaxis and is more effective than topical vasoconstrictor spray.

Role of autoinoculation in the management of cutaneous warts: a comparison study with 100% tricholoroacetic acid application

<p class="abstract"><strong>Background:</strong> Persistent and recurrent warts pose a challenge to physicians despite the availability of multiple treatment options. Autoinoculation exposes HPV antigens to the dermis and vasculature thereby activating a delayed hypersensitivity response, facilitating clearance of both local and distant warts. The aim of this study was to assess the efficacy of autoinoculation and compare it with chemical cautery using 100% trichloroacetic acid.</p><p class="abstract"><strong>Methods:</strong> A non-blinded interventional study was conducted at Goa Medical College, a tertiary care centre. Non-immunocompromised patients with 5 or more non-genital warts were included. Group 1: a wart was removed by punch biopsy, minced and implanted in the dermis. The procedure was repeated at 4 and 8 weeks. Group 2: weekly trichloroacetic acid (100%) application. Response was assessed at 4, 8 and 12 weeks in terms of percentage reduction in the number of warts. Statistical correlation with respect to age, sex, duration, number and type of warts was assessed using Welch ANOVA.<strong></strong></p><p class="abstract"><strong>Results:</strong> In group 1, 63 patients and in group 2, 54 patients completed the study. Post autoinoculation, complete clearance was seen in 46.0% and 3.2% had partial clearance. With TCA application, 33.3% patients had complete and 13% had partial clearance. Response differed with the type of warts. Palmoplantar, periungual warts and verruca vulgaris showed better response to autoinoculation. Filiform and plane warts showed better response to TCA.</p><p class="abstract"><strong>Conclusions:</strong> Autoinoculation is an efficacious treatment modality which can be performed routinely especially for palmoplantar and periungual warts which are particularly challenging to treat with other modalities.</p>