To evaluate treatment response in patients with laryngopharyngeal reflux (LPR). A prospective study of 100 patients with voice disorders was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70°rigid laryngoscope. Patients with RFS score of 7 or more were diagnosed of having LPR and were started with anti-reflux therapy for a period of 6 months. Patients were assessed at regular intervals using RSI and RFS. The prevalence of LPR in patients with voice disorders was found to be 25%. The mean RSI score improved gradually and significantly over a period of 6 months from 11.84 at presentation to 2.04 after 6 months of treatment (p value \0.001). The mean value of RFS improved from 7.92 at entry to 1.52 after 6 months of treatment (p value \0.001). However, it was found that the improvement was not significant at end of first month of treatment, and improvement in RSI and RFS scores was found only after 2 months of treatment. RSI and RFS improve significantly after treatment for 6 months with PPI like Omeprazole. But the improvement starts from the 2nd month from the onset of treatment. Treatment of LPR for at least 6 months may be indicated to attain a full resolution of physical findings.

To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60 years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.

Purpose: To establish posterior commissure hypertrophy as tool to diagnose laryngopharyngeal reflux (LPR) and to determine whether it can be used as a reliable marker for response to treatment. Materials and methods:A prospective study of 100 patients with voice disorder was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70˚ Hopkins' rigid laryngoscope. Those patients in whom RFS score was 7 or more were diagnosed to have LPR. These patients were then started on antireflux therapy along with lifestyle modification and were evaluated regularly over a period of 6 months. Results:The prevalence of LPR in patients with voice disorders was found to be 25%. Mean age was 41.48 years and the male and female ratio was 0.85:1. Posterior commissure hypertrophy was present in 60 out of 100 patients (60%). Among laryngopharyngeal reflux disease (LPRD), 23 out of 25 patients (92%) had posterior commissure hypertrophy, out of which only 2 (8.6%) patients showed complete resolution of posterior commissure hypertrophy after 6 months of treatment. A total of 10 patients (43.47%) did not show any change in grading of posterior commissure hypertrophy. And 11 patients (47.82%) showed downgrading of posterior commissure hypertrophy. Sensitivity of posterior commissure hypertrophy for diagnosis of LPR was found to be 92%, whereas specificity was 50.66%. Conclusion:Posterior commissure hypertrophy can be used as a screening tool for diagnosis of LPR but cannot be used reliably as a clinical marker for response to therapy.

angle, the diaphragmatic crura, and the phrenoesophageal ligament. Gastric motility also plays a role, with delayed emptying predisposing the patient to GERD. Thus, the mechanisms involved in preventing reflux are both anatomical and physiological as follows (Fig.