International Journal of Otorhinolaryngology and Head and Neck Surgery

Special considerations for medical management post supraglottoplasty in various clinical contexts

2025-05-28T06:46:47+0530

Laryngomalacia is the most common cause of stridor in the pediatric population. A subset of patients with laryngomalacia ultimately require surgical repair in the form of supraglottoplasty. Variability exists not only in surgical technique but also in the post operative medical management regimen. By reviewing the existing literature, we aim to summarize unique clinical contexts that should be considered and that necessitate modifications to medical management post operatively for optimal healing and outcomes.

Intracochlear electrode insertion of cochlear implant: a scoping review

2025-05-28T06:46:55+0530

Cochlear implant currently shows remarkable speech understanding performance despite use of non-optimized coding strategies for transmission of tonal information. Certain features of cochlear implant electrode arrays enable the preservation of intracochlear structures when the devices are inserted into the scala tympani. The standard location for insertion of electrode of cochlear implant is into the scala tympani. The failure of insertion of the electrode into scala tympani has been seen in clinical practice. Minimal or no insertion trauma, deep insertion to the apex of the scala tympani is possible using recently developed flexible long straight electrodes. Misplacement of cochlear implant electrode array is considered as a major complication during cochlear implantation. If there is any malformed cochlea, it needs to be diagnosed, and the right electrodes should be selected for each individual cochlea. The aim of this review article is to discuss on the current knowledge about the intracochlear electrode insertion of cochlear implant.

The middle ear cleft-embryological and anatomical aspects: a review

2025-05-28T06:46:51+0530

The air in the middle ear cleft serves as an air cushion with its tympano-ossicular system serving to match the impedance of the inner ear fluids and thus compensate for the loss of sound energy during transmission in media of different densities. The tympanic membrane on one side and the pressure equalizing eustachian tube on the other are the vital constituents of this cleft. The embryology and components developing from the ecto, meso and endoderm layers are elaborated upon.

Symptomatic cerebrospinal fluid leak secondary to sphenoidal Ecchordosis physaliphora: case report and literature review

2025-05-28T06:46:53+0530

Ecchordosis physaliphora (EP) is a rare, benign, and hamartomatous tumor that is driven from ectopic notochordal remnants. It has a usual asymptomatic presentation and is often incidentally detected in about 2% of autopsies. A 50-year-old female presented to rhinology clinic with clear nasal discharge for 6 weeks associated with frontal headache. Unremarkable neurological and ENT examination. Brain computed tomography (CT) scan demonstrated a focal bony defect at the posterior wall of sphenoid sinus with partial opacification of the sphenoid sinus showing air fluid level suspicious for cerebrospinal fluid (CSF) leakage with a small cyst. Further assessment with MRI of the brain showed signs of rhinorrhoea secondary to ecchordosis physaliphora. Patient was managed successfully with endoscopic trans-nasal skull base reconstruction. Upon follow-up at two years post-operatively, no evidence of recurrence was detected. EP is indistinguishable from chordoma histopathologically hence imaging plays a crucial role in diagnosis. EP appears as hyperintense in T2-weighted images and hypointense in T1-weighted images. Symptomatic EP cases are extremely rare and most of these cases are managed by resection via craniotomy. In addition, endoscopic endonasal trans-sphenoidal surgery (ETSS) provides a good approach. Imaging is crucial for the diagnosis of these lesions. Surgical treatment is considered the gold standard for symptomatic ecchordosis physaliphora. Endoscopic endonasal transnasal skull base reconstruction is effective for management, it is a minimally invasive approach for complete resection of the lesions with reduced hospitalization time and less postoperative complications.

Xanthoma of the larynx: a rare mucosal presentation

2025-05-28T06:48:02+0530

Xanthoma is a reactive condition of localized collection of lipid laden histiocytes with common presentation in skin, subcutis or tendon. Musoca associated xanthomatous lesions are rare presentation. These lesions may be asymptomatic or have symptoms like throat discomfort, hoarseness. These lesions are mostly associated with dyslipidemia. Due to rarity of its presentation it can be endoscopically mistaken for polyp or malignancy. Hereby, we report a case of 42-year-old male with new onset diabetes type II. He presented to ENT OPD with change in voice for few months. He underwent nasopharyngolarngoscopy and was clinically diagnosed as vocal cord polyp. Microlaryngeal excision was done and sent for histopathology. Histopathology revealed polypoid squamous epithelium covered lesion with sheets of foamy macrophages in the stroma thus confirmed the diagnosis of xanthoma, larynx. Mucosa associated xanthoma are rare presentations and may indicate a possibility of underlying metabolic disease.

A challenging case of right sided parapharyngeal cystic schwannoma: a case report

2025-05-28T06:47:58+0530

The parapharyngeal space (PPS) is a potential deep space of the neck located lateral to the upper pharynx. The clinical concerns are usually due to encroachment of tumors originating from adjacent structures such as salivary glands. These tumors are considered rare entities in the available literature in otolaryngology, so we appreciate this case and would like to present it to interested readers. A 73-year-old male patient reported swelling in the right side of the neck with difficulty swallowing, choking, change of voice, and right-sided ear pain for 9 months. Clinical examination revealed a well-defined solitary oval mass of more than 6×4 cm below the right angle of the mandible just anterior to the upper part of the right Sternocleidomastoid muscle encroaching the lumen of the oropharynx behind the right posterior tonsillar pillar, displacing the right tonsil and the parapharyngeal wall forward and medially with obvious extension to the nasopharynx and hypopharynx with normal and healthy overlying mucosa. The right side of the soft palate was pushed downward and the uvula was also displaced severely downward and to the opposite side. It was soft and cystic on palpation. A CT scan of the neck was requested which revealed a cystic mass in the right PPS. Surgical excision of the cyst by external transcervical route under general anaesthesia. Histopathological examination features are consistent with Schwannoma.

Isolated myocysticercosis of sternothyroid: a rare case

2025-05-28T06:48:04+0530

Human cysticercosis is caused by larval stage of Taenia solium manifesting clinically either as neural or extraneural cysticercosis. Neurocysticercosis along with its extraneural counterpart is the usual dictum of disease. Isolated myocysticercosis in absence of neural involvement usually goes undetected or is diagnosed differently due to its rarity. Hence, high suspicion becomes necessary in cases of cystic neck swelling and cysticercosis should always be considered as a probable diagnosis in evaluation of cystic neck lesion.

Bilateral coronoidectomy, the panacea for trismus-sequel of post op radiotherapy: a case report

2025-05-28T06:46:50+0530

Trismus is the untoward sequel of the radio therapeutic modality incorporated in head and neck malignancy. The restricted mouth opening progresses gradually leading to reduced oral intake and thereby a markedly debilitated individual. Oral exercises, dilatational devices and masticatory apparatus surgical interventions are undertaken as the case maybe.

Aberrant branching pattern and uncommon origin of inferior thyroid artery - dual rarity

2025-05-28T06:46:52+0530

Thyroid surgery is one of the most common neck procedures, and surgeons need to have a thorough understanding of the blood supply to this gland to prevent significant haemorrhage. In this report, we describe an aberrant branching pattern of the inferior thyroid artery (ITA) on the right side during a total thyroidectomy performed for papillary carcinoma of the thyroid with retrosternal extension at the ENT-HNS department of Command Hospital (Eastern Command). The left inferior thyroid artery appeared normal. The aberrant ITA originated from the right common carotid artery (CCA). Shortly after its origin, the aberrant branch ascended alongside the middle thyroid vein and entered the thyroid gland near the tubercle of Zuckerkandl. The superior thyroid arteries showed no unusual distribution. This uncommon origin and aberrant branching pattern is extremely rare, and PubMed review found no articles on this specific variation. Understanding such dual rarities and aberrant arterial patterns related to the thyroid gland is invaluable for surgeons, helping to prevent unnecessary haemorrhage.

Biofilm in cochlear implantation: our experience

2025-05-28T06:48:03+0530

Bacterial biofilm formation on cochlear implant leads to intractable infections. Though rare, it is one of the most dreaded complications which leads to explantation in most of the cases. 400 consecutive cases of cochlear implantation done at tertiary care center over a period of 7 years included. Treatment protocol followed in Biofilm and results are discussed in our case report. Two cases of biofilm where one implant could be successfully salvaged whereas other needed explantation of the implant. There is no universally accepted standardized treatment for this complication. Salvage surgery can be attempted before explantation.

Unravelling Kartagener’s syndrome in the face of recurrent polyposis: a case report

2025-05-28T06:47:56+0530

Kartagener’s syndrome (KS) is a rare autosomal recessive disorder characterized by a triad of situs inversus, chronic sinusitis, and bronchiectasis. It results from primary ciliary dyskinesia (PCD), caused by ultrastructural defects in the dynein arm of microtubules, leading to impaired mucociliary clearance. While chronic sinusitis is a well-recognized feature, nasal polyposis can sometimes be an initial presentation, making early diagnosis challenging. We report the case of a 40-year-old male who presented with persistent nasal polyposis and a history of recurrent sinus infections. Further evaluation, including imaging and clinical assessment, revealed that his nasal polyposis was part of the broader spectrum of KS. The presence of situs inversus and bronchiectasis confirmed the diagnosis. This case underscores the importance of considering KS in patients presenting with unexplained chronic nasal polyposis, particularly when associated with recurrent sinusitis. Early recognition and diagnosis are crucial in optimizing management and preventing long-term complications. A multidisciplinary approach is essential to improve clinical outcomes and quality of life for affected individuals.

Peripheral osteoma of the body of mandible in a 23-year-old female

2025-05-28T06:47:55+0530

Mandibular osteomas are rare, benign, slow-growing bone tumors most commonly found in the craniofacial region. Although typically asymptomatic, they can cause localized swelling, pain, or functional disturbances, such as difficulty chewing, when they grow large enough to impact surrounding structures. Peripheral osteomas, which arise on the external surface of the mandible, represent a distinct variant of these tumors. The lesion typically grows slowly and, on radiographs, presents as a well-defined radiopaque mass. Mandibular osteomas are often discovered incidentally due to their slow growth and lack of symptoms. However, as demonstrated in this case, they can lead to significant functional impairment, such as chewing difficulties, when they grow large enough. Surgical excision remains the treatment of choice, offering excellent outcomes with minimal risk of recurrence. Early diagnosis and appropriate surgical intervention are crucial in managing peripheral osteomas of the mandible. With proper treatment, patients can expect favourable outcomes and minimal complications.

Co-occurrence of follicular thyroid carcinoma and Warthin’s tumor of the parotid gland: a rare case report

2025-05-28T06:46:58+0530

Synchronous thyroid and parotid tumors are rarely noted in literature. There are case reports with thyroid carcinoma with parotid metastasis. In this article we present a rare case of follicular thyroid carcinoma in a 62-year-old gentleman with a synchronous right sided Warthin’s tumor. Synchronous follicular thyroid carcinoma with a Warthin’s salivary tumor is a unique presentation and has not been reported in literature before to the best of our knowledge. The surgical management of such cases, particularly in a single sitting may prove challenging in terms of incision planning and execution and head and neck surgeons should be prepared for versatile surgical planning and postoperative care.

Tunneled forehead island flap in medial orbital socket defect

2025-05-28T06:46:49+0530

Orbital exenteration in debridement of rhino-sino-orbital Mucormycosis leaves a deep bony socket with or without a bony medial or an inferior party wall, depending on the extent of intervention. The eye brow sparing technique is likely to retain sufficient skin to line this orbital cavity. Prosthetics with fine resemblance to the contra lateral eye are designed and worn to achieve facial aesthetics. These artificial eyes are usually well modeled to sit in the socket. A breach on the medial wall in an individual a sequel to severe rhinitis, sneezing, cellulitis and prosthetic friction was reconstructed with a tunneled forehead flap. These tunneled flaps are single stage procedures unlike the conventional ones with excellent cosmesis.

Rhino-orbital mucormycosis with cutaneous involvement in an HBV-positive patient: a case report and review of the literature

2025-05-28T06:46:56+0530

Mucormycosis is a rare fungal angioinvasive disease characterized by infarction and tissue necrosis. It is an opportunistic infection mainly affecting patients with impaired immunity, as seen in patients with diabetes mellitus with or without ketoacidosis, injudicious use of steroid therapy, hematological malignancy, bone marrow transplant, chemotherapy, neutropenia, as well with deferoxamine therapy. The various clinical variants of mucormycosis include rhino-orbitocerebral, pulmonary, cutaneous, and disseminated forms, among which the rhino-orbital-cerebral type is the most common. A notable rise in mucormycosis cases has been observed among patients with history of COVID-19. Contributing factors may consist of thromboembolic events linked to substandard oxygen administration practices, altered cardiopulmonary dynamics, and the injudicious use of steroids and antibiotics during COVID-19 treatment. Early diagnosis and urgent surgical and medical intervention form the cornerstone of a successful outcome. In our case report, we present a 55-year-old hepatitis B-positive patient with rhino-orbital mucormycosis with cutaneous involvement. This report emphasizes on the challenges faced in the management of patients with Hepatitis B-associated mucormycosis. We report a rare rhino-orbital mucormycosis (ROCM) case with cutaneous involvement in a patient with active Hepatitis B virus (HBV) infection and no other risk factors. The study emphasizes on early surgical and medical intervention and adequate control of comorbidity contributing to impaired immunity for a favorable prognosis.

Painless solitary mastoid osteoma: a rare presentation

2025-05-28T06:46:54+0530

The benign tumors of the temporal bone, such as osteomas, are rare. Osteomas are typically slow-growing benign tumors composed of mature bone tissue. They occasionally occur in the external auditory canal; however, they are reported to be even rarer in the mastoid bone. A 30-year-old female presented to our department in a tertiary care hospital with a hard swelling behind the left ear, diagnosed as osteoma on HRCT temporal bone scan. A complete excision was done using a postauricular approach. Histopathology confirmed the diagnosis of osteoma. Osteomas, although rare, should be considered when dealing with any hard mastoid swelling. Drilling can ensure complete removal until the normal cortical bone is reached to avoid recurrence. A cortical mastoidectomy should be done if the mastoid air cell system is involved.

A comprehensive case report of kimura’s disease: diagnosis and treatment insights

2025-05-28T06:46:52+0530

Kimura's disease is a rare chronic inflammatory disorder primarily affecting the head and neck region. We present a case of a 35-year-old male patient with swelling over the right preauricular region and right eyebrow for 5 months. The patient's blood investigations revealed elevated eosinophil count, increased absolute eosinophil count, and significantly elevated serum IgE levels. Ultrasonography suggested lipomatosis, while fine-needle aspiration cytology (FNAC) was inconclusive. Excisional biopsy of the swellings confirmed the diagnosis of Kimura's disease based on histopathological findings of hyperplastic lymphoid follicles with micro abscesses. The patient was initiated on intravenous dexamethasone, resulting in a reduction in swelling size and a subsequent decrease in serum IgE levels and eosinophil count. This case report highlights the clinical presentation, diagnostic challenges, and therapeutic response of Kimura's disease.

Case report on migrated foreign body of prevertebral space removed by lateral pharyngotomy approach

2025-05-28T06:46:49+0530

Foreign bodies in the upper aerodigestive tract are common; fish bones form 85% of those foreign bodies, which commonly impacted in the palatine tonsils, the base of the tongue or at the level of the cricopharyngeal sphincter, cervical oesophagus. Rarely, they may migrate extraluminally. Here, we are reporting a case of an ingested fishbone that had migrated to the prevertebral space, which needed a lateral pharyngotomy approach for removal.

A rare case of minor salivary gland tumor presenting as parapharyngeal tumor

2025-05-28T06:46:46+0530

Parapharyngeal space tumours (PPS) are benign, uncommon located in the head and neck region. Pleomorphic adenoma the most prevalent type of salivary gland tumour can develop from the salivary glands or start in the deep lobe of the parotid gland and spread into PPS. A 59-year-old male presented with complaints of dysphagia, voice change and swelling in the soft palate. PPS tumour was detected with endoscopy, biopsy confirmed it as salivary gland tumour and PET-CT scan findings revealed a large hyper metabolic solid soft tissue density lesion in left parapharyngeal space with local extent. Tumour excision was done through transcervical approach. Biphasic components were highlighted by CK7, SOX10, SMA, P63 using immunohistochemistry (IHC) confirming benign mixed salivary gland tumor pleomorphic adenoma. Patient was treated with IV antibiotics, IV PPI’s, IV analgesics, IV antiemetics and discharged in stable condition. PET-CT, IHC serves a vital role in diagnosis and confirmation of severity of tumour. The transcervical approach is the preferred technique for excising tumours in the parapharyngeal space that have narrow attachments.

Uncommon complication: maggot infestation around tracheostomy tube wound

2025-05-28T06:46:45+0530

“GOD’S punishment for sinners” this is the name given to Myiasis (Maggots) in Hindu mythology, symbolizing divine retribution. Myiasis is caused by the larvae of dipterous flies, which feed on living or necrotic tissue of both humans and animals. It can affect various body sites, including the skin, eyes, ears, stomach, intestinal tract, and genitourinary areas. The condition primarily involves body cavities such as the nasal cavity, ears, non-healing ulcers, exophytic malignant growths, and cutaneous tissue. While myiasis around a tracheostomy tube is rare, it presents significant challenges in diagnosis and treatment. Here, we present the case of a 62-year-old male who developed myiasis around his tracheostomy tube. Physical examination revealed severe necrosis around the tracheostomy site, with multiple live maggots present in the affected tissue. After the removal of the tracheostomy tube, the patient was able to breathe without difficulty in a room air environment. A total of 30–40 live maggots were carefully extracted using tooth forceps and curved artery forceps. Surgical debridement and removal of necrotic tissue were performed to prevent further spread of infection and promote healing. This case underscores the importance of considering myiasis as a rare but potentially serious complication in patients with tracheostomies, highlighting the need for prompt intervention to prevent systemic infection.

An intriguing instance of type 2 lepra reaction-induced granulomatous rhinosinusitis: a case report

2025-05-28T06:46:43+0530

Hansen disease, or leprosy, is a granulomatous disease caused by the bacteria Mycobacterium leprae, which is endemic worldwide. The upper respiratory tract is the main portal of entry for bacilli, and the paranasal sinuses serve as a reservoir of infection and may exhibit features of rhinosinusitis. We presented a man who manifested features of acute rhinosinusitis not respond to standard therapies incidentally found to have type II lepra reaction and showed miraculous recovery of symptoms following oral steroids and patient on close follow-up. Although leprosy has been declared eliminated globally in most countries, otorhinolaryngologists should still consider type II lepra reactions a differential diagnosis whenever a patient presents with nasal symptoms that do not respond to standard therapies.

Powered instruments for managing Thornwaldt’s cyst: our experience

2025-05-28T06:46:40+0530

Thornwaldt’s cyst (TC) is a benign, midline cystic swelling located in the roof of nasopharynx. Produced by persistent notochord remnants, it is relatively rare. There is no sex predilection. Most cases are diagnosed during the second and third decade. Nasal endoscopy is the best to visualise the disease and in case of doubt, imaging is helpful. Most of the cysts are asymptomatic but when the cyst is large or causing symptoms, surgery is the treatment of choice. A 32-year-old male, presented with bilateral decreased hearing since 2 and half years, with no other ear symptoms. Audiogram showed bilateral conductive hearing loss, with impedance audiogram showing bilateral type B curve. CT scan of Paranasal sinuses and nasopharynx was suggestive of midline cystic mass arising from roof of nasopharynx. Patient was taken up for nasal endoscopic surgery using microdebrider. A 17-year-old male, presented with complaints of nasal obstruction with no otologic symptoms like aural fullness, decreased hearing. MRI showed oval lesion attached to roof of nasopharynx. Patient was planned for surgery using coblation. TC although considered benign and often asymptomatic but it may be overlooked due to its overlapping of symptoms with other conditions. This under recognition highlights the need for increased awareness and high quality imaging in the diagnosis. While surgical intervention remains the mainstay of treatment for symptomatic cysts but minimally invasive technique like endoscopic drainage reduces recovery time and complication rate. Powered instruments use in managing cysts, resulting in minimal morbidity and improved postoperative outcomes.

Tracheostomy care knowledge and practice among nurses: insight from a tertiary hospital in Northern Tanzania

2025-05-28T06:46:59+0530

Background: Tracheostomy, a well-established life-saving procedure, is commonly performed worldwide on patients requiring prolonged mechanical ventilation. Adverse events following tracheostomy are not rare and significantly impact patients’ outcomes. Global estimates suggest that inadequate tracheostomy care leads to the death of between 10 and 60% of patients annually. The quality of nursing care after the procedure is crucial in determining patient outcome. From local settings, there is an observed increase in complications and mortality attributed to insufficient knowledge and suboptimal practice of tracheostomy care; however, the current gaps in knowledge and practice have not been systematically documented. This study aims to explore nurses’ level of knowledge and practice of tracheostomy care and its associated factors.

Methods: An eight-month analytical cross-sectional study was conducted at Kilimanjaro Christian Medical Centre, where the ear, nose, and throat ward, medical, pediatric, and surgical intensive care units were the specified study units. Data collection tools were structured questionnaires and observation checklists. Descriptive and inferential statistics were utilized in data analysis.

Results: Among 52 enrolled nurses, 75% had moderate knowledge, 13.5% had poor knowledge, and 11.5% had good knowledge. 75% of nurses had unsatisfactory practice, and 25% had satisfactory practice. Working units significantly influence nurses’ knowledge level and practice.

Conclusions: Knowledge and practice regarding tracheostomy care among nurses is limited. The development of standardized tracheostomy care guidelines, in-service continuous education, and the implementation of a comprehensive tracheostomy care training program are highly recommended to improve proficiency.

Clinicopathological patterns of benign and malignant sino-nasal tumours: insights from a single-center study

2025-05-28T06:47:00+0530

Background: Sino-nasal tumors, arising from the nasal cavity and sinuses, can be benign or malignant. Due to nonspecific symptoms and complex anatomy, diagnosis is often delayed. This study explores their prevalence, types, and distribution.

Methods: This cross-sectional observational study was conducted at the ENT and head-neck surgery department, Rajshahi medical college hospital, Rajshahi, from June 2014 to November 2014. A total of 60 patients presenting with sinonasal tumors were selected as study subjects by purposive sampling technique. Data analysis was done by statistical package for social sciences (SPSS) version 20.0. A descriptive method was adopted.

Results: This study on sino-nasal tumors found that 93.33% (56 out of 60) of the cases are benign, while only 6.67% (4 cases) are malignant. The maxillary antrum is the most affected site for malignancies (100%), followed by the nasal cavity (75%) and ethmoidal sinuses (25%). Among the malignant cases, 75% are classified as T4, indicating extensive disease. The most common benign tumors are haemangioma and rhinosporidiosis, each comprising 28.5% of benign cases. Squamous cell carcinoma (SCC) is the predominant malignant type, accounting for 75% of malignant tumors, highlighting the overall prevalence of benign lesions in the sinonasal region.

Conclusions: This study highlights that benign sino-nasal tumors, especially haemangiomas and rhinosporidiosis, are more common, while SCC is the leading malignancy. Malignant cases often present late, mainly affect the maxillary antrum, and cause symptoms like nasal obstruction and facial pain.

The efficiency of septoplasty in improving nasal symptoms caused by deviated nasal septum in Benghazi, Libya

2025-05-28T06:46:48+0530

Background: The deviated nasal septum is one of the most known causes of nasal obstruction, as well as many other symptoms.

Methods: This study employed the nasal obstruction symptom evaluation (NOSE) survey for 67 patients (female: 31 and male: 36) in Benghazi, Libya over the period from May 2024 to November 2024.

Results: Out of 100 points in the NOSE score, the mean of the total score before septoplasty was 71.791, indicating the presence of severe nasal obstruction symptoms. This mean declined to 11.716 after the surgery, which indicates the presence of only mild nasal obstruction symptoms. These results are supported by p values equal to 0.000. Moreover, before septoplasty, the mean of all answers regarding epistaxis (1.284 vs. 0.134), headache (1.328 vs. 0.119), recurrent sinusitis (0.896 vs. 0.075), and decreased sense of smell (0.925 vs. 0.118) was higher than its value after surgery. These findings are supported by significant p values (<0.05).

Conclusions: This study found that septoplasty is considered a successful treatment for symptomatic patients with deviated nasal septum.

Extracapsular dissection versus superficial parotidectomy in pleomorphic adenoma: a decade-long experience from a tertiary care center in Bangladesh

2025-05-28T06:46:42+0530

Background: Pleomorphic adenoma is recognized as the most common benign tumor of the salivary glands, while malignant tumors like mucoepidermoid carcinoma, though less frequent, present complex management challenges. This study aims to evaluate the efficacy and safety of surgical techniques, specifically extracapsular dissection (ECD) and superficial parotidectomy (SP), in Bangladesh, where data on this topic is limited.

Methods: Conducted over ten years (2014-2024) at the national center for hearing and speech for children and green life medical college and hospital, this retrospective cohort study analyzed records of 50 patients with histopathologically confirmed pleomorphic adenoma. Data included demographics, tumor characteristics, and surgical outcomes, with statistical significance set at p<0.05.

Results: The cohort had a median age of 38 years, predominantly female (58%). The median tumor size was 4 cm, with most surgeries on the right side (52%). Preoperative diagnoses indicated 79.07% pleomorphic adenomas, with FNAC confirming 84.44% benign lesions. ECD was associated with larger tumors (mean size: 7.82 cm vs. 5.65 cm, p=0.0459) and a higher malignancy rate. Facial nerve preservation rates were 73.33% for ECD and 80.65% for SP. However, ECD had a higher complication rate, including temporary facial nerve paralysis (57.14% vs. 15.38%) and seroma formation (14.29% vs. 0%, p=0.021).

Conclusions: This study underscores that pleomorphic adenoma is the predominant parotid gland pathology in Bangladesh. Both ECD and SP are effective surgical options, but careful planning and patient selection are crucial to minimize complications and enhance outcomes.

A demographic study of clinically diagnosed patients of oral submucous fibrosis visiting ENT outpatient department of a tertiary care hospital in Muzaffarnagar district, Uttar Pradesh, India

2025-05-28T06:48:00+0530

Background: Oral submucous fibrosis is a premalignant condition affecting the oral cavity. It is characterized by fibrosis of the submucosal tissues, leading to restricted mouth opening, dryness, burning sensation etc. It causes significant mortality after its transformation into squamous cell carcinoma (SCC). It has now become a global health concern.

Methods: The study was conducted amongst the patients aged 18-65 years who visited the ENT OPD of Muzaffarnagar Medical College with oral lesions from 01 January 2024 to 30 June 2024 (6 months). Of these patients that were clinically diagnosed with oral submucous fibrosis (OSMF), were given a detailed questionnaire and further studied. It was a hospital based cross sectional study conducted by Department of ENT and HNS, Muzaffarnagar Medical College and Hospital.

Results: Of the 120 cases clinically diagnosed cases of OSMF. Mean age was 42.7 years. Most patients were in 4^thand 5^thdecade of life and specifically in 31-40-years age range. Male to female ratio was 3.61: 1. Most patients came from rural areas. Gutkha was the most commonly used habit in these patients. M2 was the most common stage at which the patients visited the hospital. Muslims were predominant in the study population.

Conclusions: OSMF is an irreversible process, it has been linked to habitual consumption of betel nut, due to its high prevalence, special emphasis should be given towards its prevention and awareness. Also, due to its increased risk of malignant transformation, prompt cessation of the particular etiological agent and early management of the disease is required. Primary healthcare professionals and dentists should be familiar with its clinical presentation, diagnosis and management.

Post-operative evaluation of Eagle’s syndrome and comparison of symptomatic relief with styloid excision versus styloid fracture

2025-05-28T06:47:57+0530

Background: This study was done to evaluate symptomatic relief of patients with Eagle’s syndrome post-surgical treatment, and to compare the symptomatic relief in the styloid process excision with fracture of styloid process transorally.

Methods: A sample size of 25 patients was taken and each patient was counselled regarding surgical treatment: styloid process excision (styloidectomy), or fracture of styloid process, using transoral approach. Patients were then followed up and evaluated based on symptomatic relief, particularly pain while swallowing and throat pain using numerical rating scale.

Results: Majority of participants (56.8%) were in the 31-40 age range. The sample was predominantly female, comprising 86.4% of the participants, while males comprised 13.6%. All participants reported throat pain as their primary complaint. Radiating pain varied, with 43.2% of participants reporting headaches, followed by pain radiating to the ear (11.4%) and the jaw (4.5%). The preoperative pain levels were at a mean of 7.70±1.11, which decreased post operatively to 7.11±1.13 on day 0, 4.55±1.61 on day 7, and 3.73±1.91 after 12 weeks. There was no statistically significant difference in the mean reduction of numeric rating scale (NRS) scores between the excision and fracture groups (p=0.868).

Conclusions: Styloidectomy is an effective method for treating Eagle’s syndrome. Both styloid process excision and fracture of styloid process, through transoral route, are equally effective in providing symptomatic relief to patients with Eagle’s syndrome.

Correlation between adenoid nasopharyngeal ratio and tympanometric findings in children with obstructive adenoid enlargement in JOS University Teaching Hospital, Nigeria

2025-05-28T06:47:01+0530

Background: Adenoid enlargement plays a significant role in the pathogenesis of otitis media with effusion (OME). Adenoid nasopharyngeal ratio (ANR) of 0.67 was used as an indication for Adenoidectomy in children with obstructive adenotonsillar enlargement. OME is the commonest cause of reversible hearing loss in children. Tympanometry is an objective way the diagnosing OME. This study aimed to evaluate the correlation between ANR and tympanometry findings.

Methods: This study was a prospective cohort Hospital-based study conducted at Jos University Teaching Hospital, Nigeria between 5th of August 2020 to 5th of July, 2021. Ethical clearance was obtained. Participants had digital X-Ray postnasal space done and ANR calculated using Fujioka et al, method and subsequently had Tympanometry done and findings analysed using SPSS Version 26.0.

Results: A total of 95 patients were evaluated, 78.9% were in the age group of 2-5 years followed by 6-9 years (15.8%). There were 58(61.1%) males and 37(38.9%) females, with a M: F=1.6:1. ANR Mean was 0.76 and SD of ±0.17. Grading of the adenoids using Fujioka et al method showed 45 (47.4%) patients having grade 2 Adenoids and 50 (52.6%) patients having grade 3. Prevalence of type A, B and C tympanograms were 36.8%, 24.7% and 38.4% respectively. Strong Correlation between ANR and tympanometric findings was noted with a p value of<0.001 and correlation coefficient (r) value of 683.

Conclusions: This study showed strong correlation between ANR and tympanometric findings evidenced by high prevalence of types B and C tympanograms in patients with adenoid enlargement.

Mycological potrial of otomycosis study conducted in central Maharashtra

2025-05-28T06:46:57+0530

Background: Fungal infection of the external ear (otomycosis) is a common condition encountered by the otorhinolaryngologist in routine ENT clinic. Otomycosis associated with symptoms of itching, pain, aural fullness, aural discharge, hearing impairment and tinnitus. we have undertaken this study with the aim to describe the spectrum of fungi, clinic-pathology of patients with otomycosis.

Methods: Present study was prospective in nature conducted among 100 otomycosis patients. All patients fulfilling inclusion criteria and exclusion criteria were taken up for the study. Study was carried out over a period of 1.5 years. Results: Majority of the patients was in the age group of 16-30 years and most of them were male. Most common presenting complaint was itching (83%) followed by otalgia (54%), ear block (34%), hearing loss (31%) and ear discharge (20%). Most common fungal spp. Isolate was Aspergillus Niger.

Conclusions: Aspergillus Niger was the commonest fungal species in otomycosis with 75% sensitivity to usually started clotrimazole and fluconazole being least efficacious antifungal.

Otorhinolaryngological manifestations and hearing status in pediatric HIV/AIDS patients: a cross-sectional study from Northern India

2025-05-28T06:46:57+0530

Background: Pediatric HIV/AIDS patients are prone to various otorhinolaryngological (ENT) manifestations due to immunosuppression. Despite the widespread use of antiretroviral therapy (ART), ENT complications remain prevalent, affecting the quality of life. This study evaluates the ENT manifestations and hearing status in pediatric HIV/AIDS patients, emphasizing the role of regular monitoring and multidisciplinary care.

Methods: This cross-sectional observational study was conducted at tertiary medical college and hospital, in Northern India from November 2018 to March 2020. 276 HIV-positive children under 18 years were assessed for ENT manifestations and audiological abnormalities. The study analyzed the correlation between these conditions and CD4 counts.

Results: The majority of participants (39.9%) were aged 11-15 years, with a male predominance (63.8%). ENT manifestations were common, with chronic otitis media (19.6%) and oral candidiasis (19.2%) being the most frequent. Audiological assessments revealed hearing abnormalities in 25% of children, including 16.7% of children under 5 years with sensorineural hearing loss (SNHL). Nasopharyngeal lymphoid hypertrophy (8.6%) was the most common rhinological issue, while cervical lymphadenopathy was found in 80.8% of cases. Low CD4 counts were significantly associated with oral candidiasis and gingivitis but not with otitis media or rhinological conditions.

Conclusions: ENT complications remain prevalent in pediatric HIV patients despite ART. Regular ENT evaluations and early interventions are crucial for better management. Otorhinolaryngologists play a key role in multidisciplinary care to improve patient outcomes.

One Hz low frequency repetitive transcranial magnetic stimulation to Heschl’s gyrus and auditory cortex in patients of tinnitus: a case series and review of literature

2025-05-28T06:47:00+0530

Tinnitus affects as much as 10% of young adults at some point in their life. Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level but it may originate anywhere along the auditory pathway, from the outer or middle and inner ear to the brain's auditory cortex. There is no FDA-approved drug treatment for tinnitus as of now, and controlled clinical trials have not found any drug, supplement, or herb to be any more effective than a placebo. A new and innovative promising approach for the treatment of tinnitus is repetitive transcranial magnetic stimulation (TMS) as this directly affects tinnitus-related brain activity. We hereby report the three distinct cases of tinnitus which responded well to 1 Hz low frequency TMS s to Heschl’s gyrus and auditory cortex. The overarching goal is to enhance awareness, understanding, and management of chronic tinnitus using TMS neurostimulation therapy as there are no such reports of interventions in Indian clinical practice till date.

Malignant otitis externa: our experience

2025-05-28T06:46:44+0530

Malignant otitis externa (MOE) is a severe and potentially life-threatening infection that originates in external auditory canal. Infection begins in external auditory canal, spreading through fissure of Santorini to the surrounding structures. The clinical course is varied and outcome prediction is difficult. This review aims to explore the clinical presentation, treatment, and follow up of patient with MOE. Three patients who were known cases of type 2 diabetes mellitus (T2DM) presented to the Outpatient department with complaints of intractable otalgia and otorrhea. Some patients had cranial nerve palsy. Radiological investigations were used as adjunct for diagnosis. Clinically they were diagnosed with MOE and were treated with a 6 week course of intravenous ciprofloxacin and piperacillin-tazobactam. Response to treatment was assessed using improvement in signs and symptoms and level of inflammatory markers.

A story of the missing parotid: case report and systematic review of literature

2025-05-28T06:48:01+0530

Anatomic variations of the parotid gland are rare. We present the case of a 69-year-old male who presented with unilateral slow growing left sided cheek swelling. Radiological imaging revealed buccal space masses with characteristics similar to those of a salivary gland. Of particular note was the radiological absence of the left parotid gland. Due to the diagnostic uncertainty of this unusual presentation, the patient underwent surgical excision. An intraoral approach was utilized, with careful consideration of the facial nerve's course. Istopathological examination confirmed the diagnosis of a pleomorphic adenoma (PA) of ectopic parotid tissue. A thorough review of literature in PubMed and Google revealed only four previously reported cases, prompting us to include a brief systematic review. Given the rarity of ectopic parotid cases, it is often a diagnosis of exclusion. However, the occurrence of PA within ectopic parotid tissue underscores its importance in the differential diagnosis of unilateral cheek swelling.