Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Background and Objectives: Cochlear implantation in late implanted prelinguals necessitates a complex decision-making process for clinicians and patients due to the uncertainty of achieving adequate benefit in auditory and speech perception. This study longitudinally evaluated clinical and social outcomes of prelingually deaf children with implantation in their late childhood. Subjects and Methods: A total of 113 (49 females and 64 males) participants, with an age range of 5-15 years, were assessed for the pre-implant parameters such as hearing loss etiology, aided responses, anatomical aspects, and psychological evaluation. The Category of Auditory Performance, Speech Awareness Threshold, Speech Reception Threshold, and Speech Discrimination Score were administered to assess the patient’s auditory skills. Further, the Speech Intelligibility Rating scale was administered to evaluate the patient’s speech intelligibility at 3, 6, 9, 12, 18, and 24 months post-surgery. Subjectively perceived benefits were evaluated using the satisfaction rating scale and a questionnaire. Results: The statistical results showed a significant impact of cochlear implantation in all domains. Positive impact and improvement post-implantation were noted in all the spheres, including auditory, linguistic, social, and educational. Conclusions The study highlighted that the outcomes of a cochlear implant at a later age might not parallel with the implantation at a younger age. However, this still provides measurable benefits even after a longer period of auditory deprivation.

Background: In order to assess the effectiveness of various analgesio-sedative combinations for pain relief and sedation in pediatric dental patients, a thorough evaluation of clinical studies and patient outcomes is necessary. Methods: A total of 128 healthy, uncooperative pediatric dental patients were randomly allocated to receive one of the four combinations of drugs via the intranasal (IN) route: Group I received midazolam-ketamine (MK), Group II received dexmedetomidine-ketamine (DK), Group III received midazolam-fentanyl (MF), and Group IV received dexmedetomidine-fentanyl (DF) in a parallel-arm study design. The efficacy and safety of the combinations were evaluated using different parameters. Results: The onset of sedation was significantly faster in the DF group than in the DK, MF, and MK groups (P < 0.001). The depth of sedation was significantly higher in the DK and DF groups than in the MK and MF groups (P < 0.01). DK and DF produced significant intra- and postoperative analgesia when compared with combinations of MK and MF. No significant adverse events were observed for any of the combinations. Conclusions The DK and DF groups showed potential as analgesio-sedatives in view of their anxiolytic and analgesic effects.

Complex craniovertebral junction (CVJ) defects account for a considerable proportion of CVJ diseases. Given the heavily assimilated C1, an unfavorable C1–C2 joint orientation, an overriding C2 superior facet, a low-hanging occiput, and an abnormal vertebral artery course with a high-riding vertebral artery, placement of C1 lateral mass screws might be difficult. To address this, a novel technique for placing C1 lateral mass screws that avoid vertebral artery injury, low-hanging occiput, and overriding C2 superior facet was developed in this study. This approach enables firm fixation of C1–C2 even in difficult situations where the placement of the C1 lateral mass is challenging.

Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM. Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome. Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009). Conclusions The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

The Gantzer’s muscle is often present in the flexor compartment of the forearm. It lies underneath flexor digitorum superficialis and compresses the anterior interosseous nerve. Furthermore, this muscle frequently bestows an accessory muscle of flexor pollicis longus or flexor digitorum profundus, or sometimes together. The current meta-analysis aims to compute the prevalence of subtypes of Gantzer’s muscle. Major electronic databases (PubMed, Scopus, Google Scholar, etc.) were searched for title and abstract. After removing the duplicate citations, the titles/abstracts were shortlisted with the help of inclusion and exclusion criteria. The shortlisted titles/abstracts were downloaded or collected from the library. The data of all subtypes of Gantzer’s muscle were pooled from shortlisted published manuscripts for meta-analysis. The pooled estimate of other anatomical characteristics was also observed. A total of 59 cadaveric studies of sample size 5,903 were evaluated for pooled prevalence of flexor pollicis longus (accessory head). Similarly, the authors evaluated 14 studies of 1,627 upper limbs for flexor digitorum profundus (accessory head). The unit of analysis was per 100 upper limbs. The Pooled prevalence of accessory muscle of flexor pollicis longus and flexor digitorum profundus were 48% (95% CI, 44%–52%) and 17% (95% CI, 13%–21%), respectively. The Gantzer’s muscle is present in 2/3rd of the upper limbs. Accessory head of flexor pollicis longus is almost three times more common than the accessory head of flexor digitorum profundus. A classification of Gantzer’s muscle is needed to reduce the ignorance of these variants.

Background and Objectives: Single-sided deafness (SSD) leads to non-participation of the diseased ear in generating adequate auditory input, which results in poor speech discrimination in noisy surroundings. The present study objectively compared the audiological benefits rendered by contralateral routing of signal (CROS) hearing aid and bone conduction device (BCD) in patients with SSD >70 dB HL using the modified hearing in noise test (HINT). Materials and Methods: Patients with SSD >70 dB HL in poor and clinically normal hearing in the better ear were enrolled. Patients aged <18 or >70 years, with a history of neurological insult or ear infection in the last 3 months, mental retardation, psychiatric or developmental disorders, and diabetes were excluded. Modified HINT was performed with the affected ear unaided, aided with CROS hearing aid, and with BCD, generating three groups. Noise signal was presented at a fixed intensity of 65 dB at the neutral position in the center and speech signal was presented to either ear sequentially. The test was repeated with the speech signal fixed at the neutral position and the noise signal presented to either ear. Results: BCD led to a better signal-to-noise ratio (SNR) than CROS hearing aid in all situations except when noise was centralized and speech was presented to the affected ear. Conclusions A benefit was observed when auditory rehabilitation was used for the affected ear as demonstrated by better SNR scores. The results showed that BCD performed better than CROS hearing aid.

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.