ENT and Head and Neck Surgery

Reported sport-related concussion rates have dramatically increased recently. In response, the Guardian company has emerged as a leading manufacturer of soft-shell helmet covers. The “Guardian Cap” is a foam padded covering that fits over a helmet that aims to reduce the impact of collisions and lessen the chance of a concussion. The purpose of this study was to determine the perceived effectiveness of using Guardian Caps in preventing concussions in youth and high school football players.  In addition, this study also examined reported coaching strategies used in the attempt to reduce concussions with these athletes. United States high school and youth football stakeholders (e.g., coaches, athletic directors, youth football presidents, etc.) completed an online survey containing Likert-based and open response questions focusing on the main research goals. On average, participants reported a 40.5% decrease in concussions per year after transitioning to using Guardian Caps with their youth or high school football players.
However, 16.2% of participants would not recommend the use of Guardian Caps, citing concerns such as helmet warranty worries, helmet bulkiness, product malfunctions, and expense.  Moreover, several additional methods participants’ used in an effort to keep players safe from concussions are also discussed. Findings may assist youth and high school football coaches and athletic directors in making informed equipment and coaching decisions regarding player safety focusing on reducing concussions with their players.

CT Scans use a narrow X-Ray beam that circles around the part of body to be scanned. The data is transmitted to a computer, which build up 3D cross sectional picture. Although CT Scans cannot distinguish between inflammation and infection, they correlate with extent of disease. CT Scans have been very useful in assessing severity of the disease or response to treatment in chronic Rhinosinusitis. It is also the most reliable radiological examination to identify a fungus ball. The latest CT machines allow a complete set of axial slices to be made within a few seconds. The CT scan proved to be an excellent imaging tool as it can accurately diagnose & differentiate benign & malignant lesions, can describe the masses in terms of their origin, nature, extension, & involvement. Computerized tomography (CT) is considered the gold standard for preoperative evaluation of PNS diseases for appropriate patient selection for functional endoscopic sinus surgery (FESS). CT has some medico-legal importance as well. This is a prospective study conducted on 30 patients (from September 2018 to May 2019). Both male and female patients of different age groups with clinically suspected PNS diseases were enrolled for the study. Both axial and coronal images were acquired using multi-detector CT unit. The paranal sinuses were evaluated for: mucosal thickening, wall of sinus, fluid level, soft tissue extension, hyperdensities and masses, blockage of osteomeatal complex, and pattern of bony involvement. There was a male predominance of 54% as compared to females 46%. The chief presenting complaint was of nasal obstruction (49%), followed by a headache (40.8%), nasal discharge (30.5%), facial pain (20%), and others (37.7%). The most common CT diagnosis was chronic sinusitis (13/30) followed by polyp (7/30) and fungal sinusitis (5/30). In this study, maxillary sinus (83.5%) was the most commonly involved sinus followed by ethmoid sinus (74.7%), sphenoid sinus (43.9%), and frontal sinus (54.9%). CT was able to characterize the PNS diseases along with their extension. It could also delineate the bony involvement of PNS diseases. CT may be used as gold standard imaging modality for evaluating the Paranasal Sinus diseases.
Keywords: Paranasal sinus pathology, Chronic sinusitis, Headache, Computed tomography.

Numerous studies have concluded that for successful implementation of hearing and speech related programs in a multidisciplinary health care-based set-up, allied health care professionals specialized in any field should have appropriate knowledge and attitude towards the challenges and impact of hearing loss. So, in order to provide abundant knowledge to the allied health professionals audiologists should have evidence based knowledge which can reflect them the actual manifestation regarding the knowledge and attitude of the specialized allied health professionals in areas related hearing loss, assessment, diagnosis and subsequent audiological management. The present research is being conducted to assess the knowledge and attitude among allied health professionals across various range of hospital set up in northern India regarding hearing loss, assessment procedures and intervention options available. A questionnaire-based study (online survey) of 22 questions was adopted from similar kind of studies and was framed with the aim to assess the knowledge and attitude among allied health professionals regrading hearing loss and vestibular disorder. A total of 160 health professionals consisting of psychologist, physiotherapist, optometrist, occupational therapist recruited from medical colleges, government hospitals, primary health centers, ambulatory health care setting participated in the present study. The outcome of the present study reveals that participants had good knowledge and attitude towards the basic areas related to hearing loss and vestibular disorder. However, there are gaps in certain areas where there is a need to increase awareness and educate them regarding the role of an audiologist/speech language pathologist.
Keywords: Knowledge, Attitude, Hearing Impairment, Vestibular disorder, Allied health professionals.

We present a case of a 56 years-old woman followed by our dialysis unit for chronic kidney failure due to membranous glomerulonephritis. The patient referred to the ENT department with a swelling located in the left part of hard palate existing for some months. Intraoral examination revealed a swelling approximately 3 cm in diameter in the left part of hard palate, without signs of inflammation, fistulas or ulceration. It had a tense-elastic consistence on palpation. Performing trans-nasal fibroscopy we found an uplift of nasal cavity floor. No other signs of alteration were appreciated during endoscopy. In order to investigate the meaning of that swelling, a CT scan was required and a biopsy of hard palate mass was performed. The CT scan showed a large mass growing through the left part of hard palate, involving also oral cavity, left nasal cavity and left maxillary sinus; moreover, it dislocated the anterior portion of nasal septum. The mass had regular margins but the images showed the lost of hard palate bone and an erosion of maxillary sinus medial wall (figure 1 A, B and C). Ten days after the execution of biopsy, basing on the results we made the diagnosis of Giant Cell Granuloma (GCG). Basing on this diagnosis, we discussed the case with the patient who decided to underwent surgical excision of the mass, even if there was the risk of loosing the second incisive and the canine of left superior dental arch. The surgery was performed with a Caldwell Luc approach. After the incision and disconnection of alveolar mucosa, the tumor appeared as a red-brown bleeding mass (figure 2). Using surgical burrs, we enlarged the space between bone and tumor in order to remove the whole mass, including the margins. In this way, we performed the excision of a 3.5 x 3 cm red-brown mass, after which we refined the bone margins with burrs. We observed that the mass didn't dislocate any dental root because it didn't involve the inferior part of anterior maxillary sinus wall (figure 3). The surgery was then concluded by performing a suture of mucosal incision using vicryl 3-0 suture, removed ten days after. The histological examination of the mass revealed the presence of many multinucleated giant cells whithin areas of sclerohyalinosis. Numerous formations of small blood vessels and foci of haemorragia were present. Six months after, the patient had no more symptoms, the surgical scar of oral cave mucosa wasn't visible and the teeth were in perfect condition. A control CT scan was then performed, which showed the good results of surgery excision and no signs of relapse of the tumor. The Central Giant Cell Granuloma (CGCG) is a benign, proliferative intraosseous lesion of unknown etiology [1]. This definition was first given by Jaffe in 1953 [2]. According to WHO it consists of cellular fibrous tissue with multiple foci of hemorrhage, multinucleated giant cell aggregates and, occasionally, trabecular bone tissue [3]. It is an intraosseous lesion which peculiarly affect mandible and maxilla, more frequently on the right side than on the left side. [1] [4]. The 74 % of patients are under 30 years of age at presentation with female preponderance, with a ratio of 2:1 compared to male [5]. Even if CGCG is reported in ever bone of human body, including small bones of hands or feet, sinuses, temporal bone, skull, spine or long bones of arms and legs, the 2/3rd of cases are localized in the anterior part of mandible, especially 2nd premolar and 2nd molar with extension on the middle line. The small bones of hands and feet are the 2nd site of incidence [3]. When in the maxilla, the expansion of CGCG can affect the sinus floor, orbit and nasal passages, which may cause mobility of associated teeth, facial asymmetry and nasal deviation [4].CGCG can be distinguished in aggressive and non-aggressive forms. The non-aggressive form is usually a small, asymptomatic and slow-growing lesion and it doesn't affect cortical bone and teeth rooths. The aggressive form appears as a larger lesion (> 5 cm) with a rapid growth; clinically is characterized by episodes of pain, paresthesia and it causes root reabsorption and cortical perforation. This form has also an higher recurrence rate. [6] [7] The etiologic factor remains unknown in a half of cases [8]. Moreover, trauma is the most frequent etiologic factor reported in literature [1]. On the other hand, literature report that, in rare cases, hyperparathyroidism (HPT) could lead to develop CGCG, though HPT is mostly a cause of a lesion which appears central in bone, which is referred to as brown tumor [8]. Hyperparatiroidism causes a metabolic bone disorder due to high level of parathormon (PTH). Secondary HPT can result from chronic renal failure; these patients show hypocalcemia and hyperphosphatemia [9]. In these patients imbalance between osteoblastic and osteoclastic activity results in bone resorption, intraosseus bleeding and tissue degeneration, with formation of pseudocysts and areas of fibrous tissue containing also giant cells [10] [8]. It is our main hypothesis that secondary HPT has lead our patient to develop the lesion, because it is one of the most frequent complication of cronic kidney failure. This endocrinological disorder has already been described as a potentially cause of CGCG by many authors [8] [11]. J. Etemadi et al. reported a case of a patient with secondary HPT who developed a CGCG, which was then demonstrated being a part of a multiple brown tumor [12]. Moreover, the aspect of lesion and the rise from the center of hard palate bone are in line with literature description of hyperparathyroidism's CGCG. In fact, a variety of osseous changes may occur in conjunction with hyperparathyroidism.