International Journal of Otorhinolaryngology and Head and Neck Surgery

String test as a diagnostic tool for hypervirulent Klebsiella pneumoniae

2026-07-23T20:02:52+0530

Klebsiella pneumoniae is an emerging pathogen capable of causing severe soft tissue infections including skin and wound infections, especially in immunocompromised individuals. The common organism causing soft tissue infection is gram positive bacteria, however Klebsiella is seen as an emerging virulent pathogen. These hypervirulent strains of Klebsiella can be detected easily by the “string test.” We present two diabetic elderly males with facial soft tissue infections which tested positive on the string test. They were successfully managed with surgical drainage, debridement, and intravenous antibiotics (ceftriaxone and metronidazole), tailored to sensitivity reports. This report highlights the value of the string test in early detection of the hypervirulent strain of Klebsiella guiding prompt, prolonged aggressive treatment to ensure complete disease clearance.

Therapeutic potential of Euphorbia tirucalli L. (bone-breaking tree): a comprehensive literature review

2026-07-23T20:00:31+0530

Nasopharyngeal carcinoma (NPC) is a malignancy with high prevalence in Southeast Asia, including Indonesia, in which oxidative stress, chronic inflammation, and dysregulated cellular proliferation play important roles in carcinogenesis. Exposure to carcinogenic substances, such as formaldehyde, can induce excessive production of reactive oxygen species (ROS), resulting in cellular damage, genomic instability, and abnormal proliferation. Euphorbia tirucalli L. (bone-breaking tree) is a medicinal plant that has attracted considerable attention due to its diverse phytochemical composition and broad range of biological activities. Bioactive constituents, including polyphenols, flavonoids, diterpenes, triterpenes, and ellagic acid, have been reported to exhibit antioxidant, anti-inflammatory, and antiproliferative properties. Experimental studies have demonstrated that E. tirucalli extracts can scavenge free radicals, modulate oxidative stress pathways, suppress pro-inflammatory mediators such as NF-κB, TNF-α, and IL-6, and inhibit cancer cell proliferation through apoptosis induction. These findings suggest that E. tirucalli may exert chemopreventive effects through the regulation of oxidative stress, inflammation, and cellular proliferation. Nevertheless, current evidence remains largely limited to in vitro and animal studies. Further investigations focusing on molecular mechanisms, safety profiles, pharmacokinetic characteristics, and clinical efficacy are required to establish its therapeutic potential and support its future application as a chemopreventive agent, particularly in nasopharyngeal carcinogenesis.

Clinical and surgical significance of nasal septal hematoma following maxillofacial trauma: a contemporary review

2026-07-23T20:00:42+0530

Nasal septal hematoma (NSH), a submucoperichondrial or subperiosteal collection along the nasal septum, is an uncommon but time‑critical sequel of nasal trauma. The septal cartilage is avascular and depends on the mucoperichondrium for nutrition. Separation of the mucoperichondrium by a hematoma rapidly leads to ischemia and chondrocyte necrosis. Failure to diagnose and drain can lead to various complications like septal abscess, cartilage loss with saddle‑nose deformity, septal perforation, orbital or intracranial infection, and sepsis. The objective of this review was to summarize the contemporary evidence regarding the clinical and surgical significance of nasal septal hematoma, as Maxillofacial surgeons are often the first specialists to evaluate patients with facial trauma in emergency settings.

An eerie presentation of lymphoma: a case report of non-Hodgkin

2026-07-23T20:02:51+0530

Lymphomas are classified into Hodgkin and non-Hodgkin types according to the World Health Organisation classification of tumours of haematopoietic and lymphoid tissues. Hodgkin lymphoma arises from nodal sites, whereas non-Hodgkin lymphoma can originate from both nodal and extranodal sites.), NHL has multiple subtypes, with Diffuse large B-Cell lymphoma (DLBCL) being one of the most prevalent worldwide. We present a case of a 48-year-old female with well-controlled Retroviral disease (RVD), who presented with an isolated left ear lobule mass with final histology of Diffuse large B-cell lymphoma. This case underscores the rarity of extranodal lymphoma presenting in the ear lobule, an uncommon site for lymphoid malignancies.

Endoscopic surgical approach to a rare bulla ethmoidalis mucocele presenting as proptosis

2026-07-23T20:00:46+0530

Paranasal sinus mucoceles are expansile masses that form in the sinuses due to chronic blockage of their ostia, with occurrence in the ethmoid sinus being rare. In this case report, we present a patient diagnosed with a right bulla ethmoidalis mucocele. The patient presented with a short duration of painful right eye proptosis and diplopia. Examination revealed diplopia with restricted right eye movement, while nasoendoscopy was unremarkable. Radiological imaging identified a mucocele in the right anterior ethmoid. The mucocele was treated through marsupialization via a transnasal endoscopic approach, resulting in an improvement of the patient’s symptoms. This case report highlights this rare occurrence and role of minimal invasive surgery in treatment.

Late-diagnosed unilateral choanal atresia in a geriatric patient: a case report and literature review

2026-06-17T09:09:54+0530

Choanal atresia (CA) is a rare congenital bony or membranous occlusion of the posterior nasal passage. Unilateral cases often evade detection until late life due to compensatory mechanisms and subtle symptoms, rendering diagnoses beyond the seventh decade exceptionally uncommon, with fewer than 20 cases reported in the literature. We present the case of a 77-year-old woman with a decades-long history of intermittent left-sided nasal congestion. Diagnostic nasal endoscopy revealed complete bony obstruction of the left choana, confirmed by computed tomography, which showed an isolated unilateral CA without syndromic features or comorbid sinonasal disease. A multidisciplinary evaluation deemed surgical correction unnecessary, given her minimal functional impairment, advanced age, and satisfaction with daily activities. Conservative management with saline irrigation and observation was selected, and the patient remained stable at the 6-month follow-up. This case highlights the diagnostic challenges associated with unilateral CA in older adults. It supports symptom-guided, individualized management over routine interventions in low-risk geriatric patients, as informed by a review of historical and contemporary strategies.

A rare case of migration of clavicular Kirschner nail turned into foreign body of the neck

2026-07-23T20:00:46+0530

Kirchner wire (K-wire) fixation done for orthopedic fixation of fractures of shoulder girdles and clavicles show rare migration into the neck surrounding tissues and sometimes spinal canal. We present a unique case of a 40-year-old male with a rare migration of clavicular K-nail turned into foreign body of the neck. The patient presented with the chief complaint of pain in the left side of neck while coughing for 10 days. Imaging revealed a metallic shadow in the left deep neck space which was surgically removed via neck exploration under general anesthesia. Successful and timely removal of the nail can prevent life threatening complications. This case report highlights a rare instance of clavicular K-nail migration and its potential risks, if the smooth nail migrates into the neck. Therefore, it is imperative to choose implants with utmost care and timely explant, once the fractures have healed.

Tenosynovial giant cell tumor of the bony external auditory canal: a rare extra-articular case managed by transcanal endoscopic excision

2026-07-23T20:01:28+0530

Tenosynovial giant cell tumour (TGCT) is a benign proliferative lesion arising from synovial-type tissue, most commonly involving small joints of the extremities. Occurrence in the external auditory canal (EAC), particularly the bony canal, is exceedingly rare. We report a 20-year-old male presenting with left-sided aural fullness and conductive hearing loss of one month’s duration. Otoscopy revealed a smooth, pinkish mass arising from the anterosuperior bony EAC and abutting the tympanic membrane. Complete excision was performed using transcanal endoscopic ear surgery. Histopathology with immunohistochemistry supported localized TGCT. Postoperatively, canal patency was restored, hearing normalized, and no recurrence was observed. This case highlights the diagnostic challenge of EAC giant cell-rich lesions and supports endoscopic excision as an effective treatment.

Mediastinal abscess secondary to left paratracheal deep neck space abscess: a rare presentation and surgical management

2026-07-23T20:02:52+0530

Deep neck space infections (DNSIs) are potentially life-threatening due to their rapid progression along fascial planes into the mediastinum. Descending mediastinitis, though rare, is associated with significant morbidity and mortality if not managed promptly. We report the case of a 21-year-old male who presented with fever, dysphagia, and neck pain of 10 days’ duration. Clinical examination revealed diffuse anterior neck swelling with tenderness. Contrast-enhanced CT of the neck and chest demonstrated a left paratracheal abscess extending into the posterior mediastinum, along with pleural effusion. Despite prior treatment with intravenous antibiotics at an outside hospital, the infection progressed. The patient underwent incision and drainage of the paratracheal abscess through a midline cervical approach, followed by hemisternotomy for drainage of the mediastinal abscess. Postoperatively, he was managed with broad-spectrum intravenous antibiotics, supportive care, and daily dressings. Secondary suturing was later performed once healthy granulation tissue developed. The patient showed good clinical recovery and was discharged in a stable condition. This case highlights the importance of early diagnosis and aggressive multidisciplinary management of mediastinal extension of DNSIs. Imaging plays a crucial role in delineating the extent of disease, and combined cervical and thoracic surgical drainage is often required for definitive treatment. Mediastinal abscess as a complication of DNSI is rare but potentially fatal. A high index of suspicion, prompt imaging, broad-spectrum antibiotics, and timely surgical drainage through combined approaches are key to successful outcomes.

A case report on Pott’s spine masquerading as a midline neck swelling

2026-07-23T20:00:44+0530

Spinal tuberculosis (spinal TB) is one of the common forms of extra pulmonary TB in both developed and developing countries. A cold abscess without any acute inflammatory symptoms is characteristic of spinal TB and is seen on magnetic resonance imaging (MRI) in almost 70% of the patients. 37-year-old female patient presented to the ENT OPD with complaints of midline neck swelling for 03 months duration. The patient also gave history of fever on and off for the past 03 months. The swelling was not progressive in size for 03 months. Ultrasonography of the swelling revealed a cystic collection at the level of the thyroid gland. Contrast enhanced computed tomography (CECT) revealed an abscess extending from C2 to DV5 with a prevertebral, paravertebral and an epidural component. To conclude spinal TB could present in multiple ways. In all cases of extra pulmonary tuberculosis (EPTB) the mainstay treatment is antitubercular therapy (ATT) unless there is neurological deficit. Surgery is indicated only in cases with deformity or instability of the spine.

Sinonasal respiratory epithelial adenomatoid hamartoma: a rare clinical entity masked as nasal polyposis

2026-07-23T20:01:30+0530

A hamartoma is a benign malformation or congenital error of tissue development indigenous to a specific part of the body, common in the lung, kidney, liver, spleen, and intestine but rare in the head and neck region, particularly nasal cavity and paranasal sinuses. A 50-year-old female presented with complaints of decreased smell sensation for 7 years; snoring, bilateral nasal obstruction, serous nasal discharge which is bloodstained occasionally and mouth breathing for 2 years. On Diagnostic nasal endoscopy, on right side, a single, pedunculated, globular mass originating from roof extending up to the floor of nasal cavity, seen between septum and inferior turbinate. Bilateral full house functional endoscopic sinus surgery with posterior septectomy was done and excised mass was sent for biopsy. Histopathological examination shows fragments of polypoidal tissue lined predominantly by pseudostratified ciliated columnar epithelium with intervening goblet-like cells at some areas, underlying stroma is loose, edematous. Irregularly branched, dilated glands lined by respiratory epithelium with thickened basement membrane, abundant intraluminal mucinous secretory material along with foamy macrophages and intervening stroma appears hyalinised with mixed inflammatory infiltrate with no evidence of malignancy and diagnosis was confirmed as REAH with inflammatory nasal polyposis. REAH is very rare and self-limiting lesions which do not regress spontaneously with majority of cases presenting as polypoidal mass causing nasal obstruction, nasal stuffiness, and hyposmia, resembling chronic rhinosinusitis.

Orolaryngeal manifestations of Urbach-Wiethe disease: a case report

2026-07-23T20:00:33+0530

Lipoid proteinosis, also called Urbach-Wiethe disease, is a rare genodermatosis that presents with diverse signs and symptoms. It causes the accumulation of amorphous hyaline deposits in various organs of the body, including mucous membranes, skin and the brain. The disease starts with hoarseness in childhood and then progresses to involve other systems. We report two cases of the disease, one of a 14-year-old girl who presented with hoarseness. The patient had scarring of the skin over the face and upper limb, and deposits were visible in the oral cavity. Office endoscopy revealed laryngeal deposits. On brain imaging, bilateral mesial temporal lobe calcifications were noted. Biopsy of the lesions was suggestive of lipoid proteinosis. Second, of a 2 years old male child, who presented with a weak cry and skin lesions over the upper limbs and was diagnosed by a genomic analysis. This case series adds to the sparsity of the literature with regard to this medical rarity. The girl was started on oral acitretin, topical triamcinolone and speech therapy while the second child was started on oral acitretin. Thus, our case series highlights the diverse nature of this disease, diagnostic modalities and the importance of multimodal therapy for this disease.

Transmandibular surgical approach in managing a giant trigeminal schwannoma: a rare case with postoperative complication

2026-07-23T20:00:32+0530

Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells. Schwannomas can occur along the pathway of any somatic or sympathetic nerve. The nerves most commonly involved in schwannomas of the head and neck are the vagus and the cervical sympathetic chain. Trigeminal schwannomas are infrequent, benign tumors originating from Schwann cells. These tumors, particularly when large, mostly have late presentations and pose significant surgical challenges due to proximity to vital cranial structures. We present a rare clinical case of a 33year old female patient with a chief complaint of swelling on face, diagnosed as suffering from benign tumor extending from cranial base (from foramen ovale) to the parapharyngeal space. Mandibular access osteotomy was done to expose the tumor. Surgical excision of the tumor was done along with the preservation of the nerve. The patient experienced notable complications in the postoperative period, requiring multidisciplinary intervention. This report highlights the surgical planning, challenges in operative technique, and complexities of the postoperative care.

A rare case of anatomical variation of aberrant right common carotid and subclavian arteries: its clinical and surgical significance

2026-07-23T20:00:45+0530

Aberrant Right subclavian artery is not a very uncommon anatomical anomaly but its association with Aberrant Right common carotid artery is an extremely rare anomaly. We present a rare case of a 29-year-old female with aberrant right subclavian Artery with Aberrant Right common carotid artery running across the trachea undergoing Total Thyroidectomy. A 29-year-old female patient came with right-sided neck swelling and dysphagia for 15 years. Pre-operative work up revealed a malignant lesion of the thyroid with anomalous vascular supply which was removed via total thyroidectomy under general anesthesia with major vascular supply preservation. Successful and complete excision of the malignant thyroid swelling with neck dissection along with vascular & nervous supply preservation. Anatomical anomalies must be borne in mind prior to any procedures, especially to the neck. The presence of these anomalies may pose challenging situations during thyroidectomies and neck dissections. Thus, avoiding a catastrophic outcome in a straightforward procedure.

The integration of gamification strategies within competency-based otorhinolaryngology residency training: a comprehensive analysis of pedagogical shifts, technological implementations and professional outcomes in the U. S. medical education system

2026-07-23T20:00:43+0530

Postgraduate medical education is transitioning toward a structured competency-based medical education (CBME) framework, utilizing ACGME Milestones 2.0 and Entrustable Professional Activities (EPAs) to objectively measure resident progression from novice to expert. Objectives were to evaluate the integration of gamification strategies, applying game-design elements within non-game settings, in otorhinolaryngology residency, specifically analyzing their impact on learner engagement, operative technical proficiency, and professional outcomes. A comprehensive analysis evaluated the implementation of digital pedagogy (e.g., podcasts, microblogging), workplace-based assessment platforms (EMYWAY), cognitive judgment tools (SICKO), and immersive simulations (VR/AR/MR) for core surgical skills acquisition. Educational preferences are shifting toward digital resources; notably, residents engaging in gamified discussions on platforms like Twitter increased their ABSITE percentile rank by an average of 13.7%. Digital assessment tools such as EMYWAY foster a shared understanding of competency between faculty and trainees (r=0.531). Furthermore, VR simulations for emergency procedures and temporal bone surgery significantly enhance procedural accuracy, with VR cricothyrotomy improving performance in 92% of participants. Tools like SICKO also effectively differentiate surgical expertise levels (p=0.001). Gamification effectively modernizes surgical training by bridging the gap between theoretical knowledge and operative mastery. Strategic recommendations emphasize integrating validated simulators and AI-driven adaptive learning into weekly training to support objective entrustment decisions.

Trigeminal cardiac reflex in oral and maxillofacial surgery: a systematic review

2026-06-05T07:04:51+0530

The trigeminocardiac reflex (TCR) is a brainstem reflex triggered by stimulation of the trigeminal nerve, resulting in sudden cardiovascular disturbances such as bradycardia, hypotension, arrhythmias, and, in severe cases, asystole or cardiac arrest. This systematic review evaluated the clinical characteristics, triggering factors, management strategies, and outcomes of TCR in oral and maxillofacial surgery. A systematic search was conducted according to PRISMA guidelines using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published between 2009 and 2022. Eligible studies included case reports, case series, observational studies, and reviews involving TCR during oral and maxillofacial procedures. Ten studies met the inclusion criteria. TCR was most associated with orbital, maxillary, and zygomatic manipulation, including Le Fort I osteotomy and zygomatic fracture reduction. Clinical manifestations ranged from transient bradycardia and hypotension to severe arrhythmias and intraoperative asystole. In most cases, immediate cessation of surgical stimulation, anesthetic adjustment, and administration of atropine successfully reversed the reflex. Although severe complications were uncommon, isolated cases of cardiac arrest were reported. Early recognition, careful surgical manipulation, continuous intraoperative monitoring, and prompt management are essential to minimize morbidity and improve patient safety during maxillofacial surgery.

Oropharyngeal cartilaginous choristoma: a systematic review of the literature with novel clinical insights

2026-07-23T20:00:29+0530

Cartilaginous choristoma of the oropharynx is an exceptionally rare benign lesion characterised by the presence of mature hyaline cartilage in an anatomical location where cartilage is not normally found, and its clinical, radiological, and histopathological characteristics remain poorly defined because of its rarity. We systematically reviewed all reported cases of oropharyngeal cartilaginous choristoma in the English-language literature and present a novel case of cartilaginous choristoma arising from the lateral pharyngeal wall. A systematic review was conducted according to the PRISMA 2020 guidelines by searching PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar from database inception to June 2026. All studies reporting cartilaginous choristomas of the oropharynx were included, and descriptive statistical analysis was performed. Eighteen studies met the inclusion criteria, comprising 28 discrete lesions. The palatine tonsil was the predominant site (85.7%). The mean patient age was 28.6 years (range, 4-50 years), with a male-to-female ratio of 1.2:1. Recurrent tonsillitis was the most common presenting symptom (64.3%), while prospective studies reported an incidence of 3–6% among routine tonsillectomy specimens. Histopathological examination consistently demonstrated mature hyaline cartilage without atypia. Complete surgical excision was curative in all reported cases, with no documented recurrences. These findings indicate that oropharyngeal cartilaginous choristoma most commonly presents incidentally in tonsillectomy specimens or as a mass, producing obstructive symptoms, and that complete surgical excision, including the perichondrium, is curative. Although rare, this entity should be considered in the differential diagnosis of oropharyngeal masses to ensure accurate diagnosis and appropriate management.

Cognitive debiasing strategies in otorhinolaryngology: a framework for clinical excellence and patient safety

2026-07-23T20:00:34+0530

To present a comprehensive debiasing framework to mitigate systematic cognitive errors in Otorhinolaryngology Head and Neck Surgery (OHNS), establishing it as a fundamental requirement for patient safety and clinical excellence. This study utilizes a systematic review that identified 71 OHNS-relevant cognitive biases. It evaluates the dual-process theory of cognition, differentiating rapid, intuitive System 1 processing from analytical System 2 deliberation and synthesizes current evidence regarding structural safety protocols, educational mnemonics, and artificial intelligence (AI) applications. Cognitive biases span the entire patient care lifecycle and contribute to approximately 20% of surgical "never events," with confirmation bias being the most prevalent factor. Effective mitigation strategies include cognitive forcing functions such as the WHO surgical checklist, "Stop, Pause, and Agree" protocols, and the SKAIR mnemonic for resident assessments. Furthermore, explainable AI (XAI) and large language models (LLMs) demonstrate significant promise as "second observers" to objectively challenge subjective clinical assessments. Achieving clinical excellence in OHNS requires a paradigm shift from individual awareness to systemic institutional change. By embedding simulation-based education and Bayesian decision-making into daily surgical practice, the specialty can ensure accurate and precise decision-making, though future research is necessitated to experimentally validate these interventions in real-world clinical environments.

The utility of transoral robotic surgery for oropharyngeal squamous cell carcinoma: functional and perioperative outcomes

2026-07-19T09:16:05+0530

Background: To evaluate the functional recovery, oncologic and perioperative outcomes of patients undergoing transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).

Methods: A retrospective cohort study of 103 patients who underwent TORS between 2015 and 2024 was conducted. Patients were stratified into diagnostic-TORS (patients with head and neck cancer of unknown primary origin (HNCUP), n=28) and therapeutic-TORS groups (resection of T1-T2 OPSCC, n=75). The primary outcomes were oropharyngeal function post-TORS. Secondary outcomes related to HNCUP detection, treatment de-intensification, overall survival (OS), and surgical complications.

Results: Immediate oral intake was observed in 90.3% of patients. No patients required long-term gastrostomy feeding. A progressive improvement in diet and fluid levels was observed, with 88.9% of patients achieving a normal diet within 12 months. At 12 months post-TORS, 90.3% of patients recovered their premorbid speech level. HNCUP identification rate was 42.9% with diagnostic-TORS. Five-year OS was 89% (95% CI, 78-94%). Tumours with positive p16 status had significantly improved OS (94% vs. 63%, p=0.001). Although margin status did not demonstrate statistically significant differences in OS (p=0.313), all patients requiring re-excision achieved clear margins, facilitating treatment de-intensification. Post-operative bleeding was observed in 6.8% of patients, with a peri-operative mortality rate of 1.9%.

Conclusions: TORS is effective in oropharyngeal cancer management, delivering excellent functional and survival outcomes. Our study supports the role of TORS in treatment de-intensification. The risk of significant haemorrhagic complications necessitates rigorous perioperative protocols.

T1 and T2 glottic squamous cell carcinoma: endoscopic laser surgery versus radiotherapy experience in a cancer center in Mexico

2026-07-23T20:02:59+0530

Background: Radiotherapy and endoscopic laser surgery (ELS) has been considered the primary treatment for laryngeal cancer. This study aims to compare ESL and radiotherapy in terms of organ preservation, disease-free survival, overall survival and cancer-specific survival.

Methods: A retrospective study using database of T1-T2 glottic cancer treated with radiotherapy and ELS. Disease-free survival, overall survival and cancer specific survival (CSS) for both groups according to Kaplan-Meier.

Results: 108 patients received radiotherapy and 98 patients underwent ELS were analyzed. Organ preservation rate was higher in the ELS group (88.8% vs 84.3%) p=NS. The percentage of patients alive without disease was higher in the ELS group (85.7% vs 58.3%) (p< 0.00). The five-year general OS rates were 93% and 91% in the ELS and radiotherapy group, respectively; while the ten-year OS rates were 93% and 63%, respectively. The five-year and ten-year OS rates for T1 and T2 (p=NS). Five-year CSS in the ELS and radiotherapy group was, respectively, 86% and 85%, whereas ten-year CSS was 83% and 50%, respectively (p=NS). A sub analysis of recurrent cases was performed for both groups. Organ preservation was achieved in 71.1% of cases in the ELS group compared with 58% in the radiotherapy group (p=0.23).

Conclusions: T1 tumors should be exclusively treated with ELS or open surgery, diagnosis and treatment can be combined in a single surgical procedure. Before administering radiotherapy, a diagnosis is needed. T2 tumors should be properly selected for their management and many approaches are available. Organ preservation is similar for both groups.

The study of hearing aid durability and microbial colonization in a coastal region in India

2026-07-23T20:00:30+0530

Background: The global burden of hearing impairment necessitates the widespread deployment of hearing aids, which serve as the primary modality for audiological rehabilitation. However, the long-term efficacy, structural longevity, and hygienic safety of these devices are significantly challenged by extreme environmental factors. High-humidity coastal environments, characterized by atmospheric salinity and elevated temperatures, pose a unique and severe threat to the sophisticated microelectronics of these devices. Furthermore, these climatic conditions fundamentally alter the microenvironment of the external auditory canal, promoting the rapid growth of pathogenic bacterial and fungal biofilms on customized earmolds and acoustic domes. This dual threat frequently leads to device failure and recurrent auricular infections.

Methods: A comprehensive, mixed-methods observational study comprising a three-year retrospective analysis of audiology repair logs and a cross-sectional microbiological study of patient earmolds was conducted in the Department of ENT, Father Muller Medical College, Mangalore located in the monsoonal coastal region of Karnataka, India. Device failures were systematically categorized, and earmold swabs were cultured for aerobic bacteria, anaerobic bacteria, and fungal flora using established microbiological protocols.

Results: Analysis of 412 distinct hearing aid repair logs revealed a high incidence of moisture-related mechanical and electronic failures, predominantly affecting acoustic transducers. Receivers were the most frequently failed component (38.3%), followed closely by microphones (29.1%). The cross-sectional survey of 150 active earmolds demonstrated an alarming 78% microbial colonization rate. Fungal elements, particularly Aspergillus spp., and opportunistic bacteria, notably P. aeruginosa, were the most prevalent isolates, frequently presenting as polymicrobial biofilms.

Conclusions: High-humidity coastal climates significantly accelerate the degradation of hearing aid microelectronics through galvanic corrosion and moisture ingress, while simultaneously fostering opportunistic, pathogenic microbial biofilms within the ear canal. Enhanced environmental structural protections, active dehumidification technologies, and highly stringent antimicrobial hygiene protocols are absolutely essential to sustain audiological rehabilitation and safeguard otologic health in tropical regions.

Incidence of malignancy among thyroid swellings

2026-07-23T20:00:33+0530

Background: Thyroid swellings are common in clinical practice, with most being benign, although a small but significant proportion may harbor malignancy. Therefore, this study was conducted to determine the incidence of malignancy among thyroid swellings in a tertiary care hospital setting.

Methods: This observational cross-sectional study was conducted at the Department of ENT and Head-Neck Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from June to December 2014. Fifty patients with clinically and sonographically diagnosed thyroid swellings undergoing thyroidectomy were included to determine the incidence of malignancy. All patients were evaluated clinically and investigated with FNAC, thyroid function tests and ultrasonography, with histopathology confirming the final diagnosis.

Results: Among 50 patients, most were aged 31–40 years (40.0%), with females 84.0% (F:M=5.25:1) and middle class 70.0%. Neck swelling was present in 100%, with dysphagia 8.0%, pain 6.0%, dyspnoea 2.0% and lymphadenopathy 2.0%. Most presented within 6 months–2 years (48.0%). Solid nodules were 70.0% and multinodular goitre 68.0%. FNAC showed colloid goitre 76.0%, with malignancy 14.0% (7 cases). Papillary carcinoma accounted for 85.7%, with metastasis 14.3%. Hemithyroidectomy was most common (60.0%), followed by total thyroidectomy (22.0%).

Conclusions: Thyroid swellings show a 14.0% incidence of malignancy, higher in males and extreme age groups, with papillary carcinoma being the most common type.

Low serum prestin level as a potential biomarker for sudden sensorineural hearing loss: a cross-sectional study

2026-07-03T06:53:53+0530

Background: Prestin (SLC26A5) is a membrane motor protein that has a role in amplification and electromotility of the outer hair cells of the cochlea. Sudden sensorineural hearing loss (SSNHL) is a rapidly emerging hearing impairment caused by damage to the cochlear hair cells. Therefore, this study aims to analyse the potential of prestin serum as a biomarker in establishing the diagnosis of SSNHL.

Methods: This study is a cross-sectional analytical observational study conducted at Prof I.G.N.G. Ngoerah general hospital, a tertiary hospital in Bali involving 13 SSNHL patients who had not yet received therapy, as well as 12 healthy control subjects. Serum prestin levels were assessed using enzyme-linked immunosorbent assay (ELISA), and audiometric examinations were performed to assess the degree of hearing loss. Data were analyzed using IBM SPSS statistics version 30.0 computer program. The normal serum prestin level was identified through receiver operating characteristic (ROC) curve analysis. The analysis was further performed with Chi-square or Fisher's exact as alternative tests and logistic regression by controlling the confounding variables to determine the risk factors of SSNHL. Statistically significant result defined as p value <0.05.

Results: According to the ROC curve analysis, the normal serum prestin threshold was 450.7 pg/ml. Serum prestin levels <450.7 pg/ml were categorized as low, and >450.7 pg /ml as high. Based on the Fisher exact test, low serum prestin levels were significantly associated to SSNHL with the OR 7.7 (95% CI 1.159-11.171, p=0.041). Logistic regression analysis was further performed by controlling the confounding variables and showed that low serum prestin level was significantly an independent predictor of SSNHL with an Adjusted OR 15.4 (95% CI 1.028-230.9, p=0.0048).

Conclusions: Low prestin serum levels are significantly promising potential biomarkers in the diagnosis of SSNHL.

Predictors of functional and aesthetic failure following closed reduction of nasal fractures: a prospective cohort study

2026-07-19T09:16:06+0530

Background: Closed reduction (CR) is the standard intervention for nasal fractures, yet historically high failure rates persist. This prospective study aims to analyze clinical outcomes, complication rates, and predictors of surgical failure following CR utilizing validated patient-reported outcome measures (PROMs).

Methods: A prospective cohort study of 185 patients undergoing CR for isolated nasal bone fractures was conducted from May 2024 to May 2025. Outcomes were assessed pre-operatively and at 6 months using the nasal obstruction symptom evaluation (NOSE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scales. Surgical failure was defined as moderate-to-severe persistent obstruction (NOSE>30), significant aesthetic dissatisfaction (SCHNOS-C), or the necessity for secondary Septorhinoplasty. Multivariate logistic regression identified independent risk factors for failure.

Results: CR resulted in significant improvement in mean NOSE and SCHNOS scores at 6 months (p<0.001). However, the overall surgical failure rate was 14.59% (n=27), with 9.72% (n=18) requiring secondary septorhinoplasty within 12 months. Multivariate analysis revealed that intervention delay >7 days (aOR=2.45, p=0.04) and concomitant cartilaginous septal deviation (aOR=3.61, p=0.01) were robust independent predictors of functional and aesthetic failure. Complication rates were minimal (3.24%).

Conclusions: While CR is a safe primary treatment, prospective PROM integration reveals a failure rate of approximately 15%. Unaddressed cartilaginous septal trauma is a primary driver of these failures. Patients with endoscopic evidence of septal deviation should be counseled regarding the high risk of CR failure and considered for primary open reduction or early functional Septorhinoplasty.

Effects of submucosal dexamethasone in minimizing postoperative pain, swelling and trismus in lower third molar surgery: a randomized double-blind study

2026-07-17T09:23:34+0530

Background: Aim of the study was to evaluate the efficacy of 8 mg pre-operative submucosal dexamethasone administrated in the vicinity of lower third molar in reduction of post-operative pain, swelling and trismus after trans-alveolar extraction.

Methods: This randomized prospective double-blind study included 60 ASA grade I patients with moderately difficult impaction (according to winter’s war line and Pell and Gregory’s classification). Patients were randomly divided into two groups. Group A (study group) patients received 8 mg of submucosal dexamethasone immediately after the onset of local anesthesia and group B (control group) received 2 ml of normal saline (placebo) respectively. Assessment of swelling, mouth opening, and pain was done at intervals of 1^st, 3^rd, and 7^th post-operative days.

Results: There were 24 (80%) males and 06 (20%) females in group-A and 22 (73.3%) males and 8 (26.7%) females in group B. Administration of pre-operative submucosal dexamethasone had statistically significant effect in reduction of pain, swelling and trismus in all the postoperative evaluation days (p<0.05) as compared to control group.

Conclusions: Pre-operative 8 mg submucosal dexamethasone injection in the vicinity of impacted lower third molar, is significantly effective in reduction of postoperative pain, swelling and trismus.

Caregiver burden in primary caregivers of pediatric cochlear implantees: a cross-sectional study from a tertiary referral centre in Southern India

2026-06-12T07:10:36+0530

Background: Caregiving for paediatric cochlear implantees (CI) is challenging, underreported and has not been quantified. This study has implications for improving support systems for the primary caregivers of paediatric cochlear implantees.

Methods: The analysis was done using the Zarit burden inventory (ZBI), the Oh and Seo family caregiver burden scale (FCBS) and the Pai and Kapur family burden interview schedule (FBIS), and the burden of care was correlated with socio- economic-demographic factors. 119 implanted children during the period 2018-2025 and their caregivers were recruited. All patients had undergone at least three months of auditory-verbal rehabilitation therapy (AVT).

Results: The mean age at implantation was 3years. All the primary caregivers were female. 83% of the primary caregivers were the mothers of the implantees. 21.8% of the respondents had additional responsibility in the form of another sick person at home. The mean duration of AVT was 11.94 months. The mean distance of the AVT centre from the patients’ homes was 42 km. The age of CI was statistically significant for financial burden in the FCBS. The distance of the AVT centre contributed to a statistically significant emotional burden. Caregiving was significantly easier for children for whom at least 3 years had elapsed since surgery. The ZBI screening tool correlated well with the FCBS and the FBIS for documenting burden.

Conclusions: Caregivers burden (CB) is significant economically and when it involves younger children, recent surgery and travel for AVT. Women bear all caregiving responsibilities at home. The ZBI can be used as a rapid screening tool for CB.

Impact of patient adherence to oral versus intratympanic steroid protocols on hearing outcomes in sudden sensorineural hearing loss

2026-07-19T09:16:04+0530

Background: Systemic and intratympanic steroids (ITS) are primary treatments for idiopathic sudden sensorineural hearing loss (SSNHL). While efficacy is known, real-world adherence to high-dose oral tapers and its impact on outcomes remains under-reported. We compared adherence rates between oral (OST) and ITS therapy and evaluated their correlation with hearing recovery.

Methods: This retrospective cohort study included 245 adults with unilateral SSNHL. Patients received a 14-day oral prednisolone taper (OST group) or four intratympanic Dexamethasone injections over two weeks (ITS group). OST adherence (defined as taking ≥80% of the prescribed dose) was assessed via refill records and patient diaries. ITS adherence required completing all injections. Multivariate logistic regression adjusted for baseline imbalances.

Results: Of the 245 patients, 138 received OST and 107 received ITS. The ITS group demonstrated significantly higher adherence (96.3%) versus the OST group (78.3%; p<0.001). OST non-adherence resulted mainly from hyperglycemia (30%), insomnia (25%), and gastrointestinal distress (20%). Adherent OST patients achieved a mean Pure Tone Average improvement of 24.5 dB, compared to 14.2 dB in non-adherent patients (p=0.004). Age >65 and diabetes history were independent predictors of poor OST adherence.

Conclusions: Adherence to high-dose oral steroids for SSNHL is suboptimal compared to intratympanic administration due to systemic side effects, significantly compromising hearing recovery. Intratympanic therapy may be the preferred primary modality for patients with non-adherence risk factors like diabetes or advanced age.

Post-operative surgical site infection after type 1 tympanoplasty: an institutional experience

2026-07-23T20:03:00+0530

Background: Tympanoplasty is a routinely performed surgery for treating the COM mucosal type of disease. Complications after surgery is not uncommon and can compromise the surgical outcomes. However, the incidence of surgical site infections after ear surgery is declining day by day because of the use of pre-op antibiotics, highly sterilized instruments and clean surgical fields. This paper presents a study on post-operative infections after tympanoplasty and investigates the potential cause responsible for it.

Methods: This prospective study was done over a period of 9 months. The data of 100 patients who were operated for COM mucosal (inactive) type of disease under general anaesthesia, under the care of both the senior and junior surgeons were recorded. There surgical outcomes were evaluated and all cases of locally infected ears were assessed and followed up.

Results: Concerning the SSI postoperatively, 4 cases were diagnosed (4%) within the period of 1 month of follow-up, and a significant association was found with the patients operated by juniors, poor hygienic practices by patients, and the comorbidities associated with the patients.

Conclusions: The occurrence of complications after ear surgery is less rare than previously thought. Inappropriate surgery by junior surgeons is found to be one of the causes of complications resulting in graft failure. Maintaining personal hygiene post-operatively also plays an important role in keeping the surgical site clean, so patient counselling regarding personal hygiene and head hygiene is very important. And co-morbidities like diabetes mellitus should be taken into consideration in view of avoiding SSI.

Randomized control trial for comparison of teflon and titanium piston in stapedotomy

2026-07-23T20:00:44+0530

Background: This study aims to compare the improvement in hearing after stapedotomy using Titanium versus Teflon pistons in patients with otosclerosis, and to assess postoperative auditory and vestibular symptoms, such as tinnitus and vertigo, in both groups.

Methods: A randomized controlled trial was carried over a period of 12 months.44 patients aged 18-60 with otosclerosis were divided into 2 groups by random allocation. Group A was subjected to stapedotomy with Teflon piston and group B received Titanium piston. All patients were followed up post operatively at 3, 6 and 12 weeks, to assess audiological outcomes and post-operative symptoms.

Results: The mean pre-operative air-bone gap (ABG) was 32.95±4.83 dB in the Teflon group and 33.23±5.19 dB in the Titanium group, with no significant difference. At 3 and 6 weeks post operatively, mean ABG further improved parallelly in both groups. At 12 weeks, final mean ABG was 9.68±3.03 dB in the Teflon group and 11.05±3.86 dB in the Titanium group, with no statistically significant difference. Excellent ABG closure (≤10 dB) was achieved in 72.7% of Teflon patients and 59.1% of Titanium patients. Post op tinnitus and vertigo were also comparable in both groups.

Conclusions: Stapedotomy using either Teflon or Titanium piston prostheses results in significant and clinically meaningful improvement in hearing among patients with otosclerosis. Thus, both pistons can be effectively used based on availability and practical considerations to achieve excellent functional hearing outcomes when meticulous surgical technique is employed.

Cross-platform discrepancies in smartphone sound level meter applications: a multicenter clinical and urban acoustic analysis in Indian context

2026-07-19T09:16:03+0530

Background: The widespread adoption of tele-audiology necessitates accurate environmental noise monitoring via patient smartphones. This study evaluates the acoustic accuracy and clinical usability of 10 sound level meter (SLM) applications across iOS and Android platforms, comparing performance in controlled audiometric environments against unstructured, real-world Indian settings.

Methods: This cross-sectional study incorporates a three-phase design. Phase 1 assessed technical accuracy in a sound-treated booth using pure tones and narrowband noise (250-8000 Hz). Phase 2 evaluated real-world performance, contrasting steady-state noise against impulsive urban traffic noise, highly reverberant outpatient departments (OPD), and a neonatal intensive care uznit (NICU). Measurements utilized a reference class 1 SLM alongside an iPhone 15 Pro, a flagship Android (Samsung S24), and a budget-tier Android. Phase 3 assessed app usability using the mobile application rating scale (MARS).

Results: Cross-platform applications demonstrated significant platform-dependent variability. Apps that were accurate on iOS frequently overestimated noise on Android hardware (+3.80 to +4.60 dBA), while native Android apps underestimated noise on the same device (-5.40 dBA), highlighting a software-hardware calibration disconnect rather than uniform hardware failure. Budget-tier Androids exhibited the highest error margins (up to±9.5 dBA), particularly during impulsive urban noise and high-frequency tones (>4000 Hz).

Conclusions: Smartphone SLM applications exhibit profound cross-platform discrepancies. Solely validating these tools in controlled laboratories is insufficient for clinical application. To ensure reliable occupational and tele-audiology screening, particularly in resource-limited rural networks, clinicians must utilize standardized biological calibration protocols to derive device-specific correction factors.

Perceptual and acoustic voice analysis in participants with post thyroidectomy

2026-07-23T20:00:41+0530

Background: Voice changes are common concern for participants who underwent thyroidectomy, even when the laryngeal nerves are preserved. To understand these changes, a comprehensive voice assessment is necessary, which involves a multidisciplinary team of professionals in evaluating and treating participants with post-thyroidectomy. The study aimed to assess and compare perceptual and acoustic voice analysis in healthy and participants with post-thyroidectomy.

Methods: It was an analytical cross-sectional study. A total of 40 participants, aged 20 and 55 years were included in Group I and Group II. VHI-H, and MDVP were used for the study which provides insights into various parameters of voice. The collected data was entered into an Excel sheet, and statistical analysis was performed with SPSS version 27.

Results: Statistical analysis revealed a significant difference in perceptual evaluation of voice in participants with post-thyroidectomy when compared with healthy participants (p<0.05). Statistically significant difference was also observed in the acoustic voice parameters in participants with post-thyroidectomy and healthy participants (p<0.05). Significant positive correlation was found among VHI-H as well as most MDVP parameters.

Conclusions: Post-thyroidectomy can significantly alter both perceptual and acoustic voice parameters. The significant correlation further underscores the importance of incorporating both perceptual and acoustic evaluations in clinical voice assessment. These insights support the importance of routine voice monitoring in participants with post-thyroidectomy to ensure timely identification and management of voice problems, ultimately improving patient care and their QOL.

A clinical study of cochlear implant electrode placement via posterior tympanotomy approach in cases with varying types of round window visibility

2026-07-23T20:00:41+0530

Background: Cochlear implantation (CI) is an established intervention for severe to profound hearing loss not benefiting from hearing aids. Posterior tympanotomy is the standard surgical approach to access the basal turn of the cochlea for electrode insertion via the round window or cochleostomy. However, the visibility and accessibility of the Round window membrane (RWM) may vary depending on anatomical variations. This study aimed to evaluate the utility of the Saint Thomas Hospital (STH) classification in assessing round window visibility and its relationship to the practical ease of electrode insertion.

Methods: This retrospective study analysed 511 cochlear implantations performed via the posterior tympanotomy approach in 476 children. The round window was classified according to the STH classification. The method of electrode insertion used in each case was documented and analysed.

Results: Type IIA round window was the most common variant, observed in 282 cases (55.2%), while Type III was the least common, occurring in 64 cases (12.5%). Direct round window insertion was feasible in all cases with Type I and Type IIA round windows. In 96 cases with Type IIB round window, an extended round window technique was required for electrode insertion. All 64 cases with Type III round window required cochleostomy due to inadequate round window access.

Conclusions: The study demonstrates the clinical utility of the STH classification in predicting the feasibility of round window electrode insertion during cochlear implantation. This classification can assist surgeons in determining the most appropriate method of electrode insertion based on intraoperative STH classification.

Diagnostic accuracy of fine needle aspiration cytology for thyroid nodules under the 2023 Bethesda system: a retrospective analysis with future perspectives on artificial intelligence and molecular integration

2026-07-23T20:01:27+0530

Background: Thyroid swellings are common clinical presentations in ENT and pose diagnostic challenges in differentiating benign from malignant lesions through clinical and ultrasonographic evaluation alone. FNAC offers a minimally invasive, rapid, cost-effective preoperative tool, though it is limited by an inability to differentiate certain indeterminate categories, such as follicular adenoma from follicular carcinoma. Modern adjuncts, including artificial intelligence (AI) and molecular testing, are increasingly explored to bridge these diagnostic gaps.

Methods: This retrospective study was conducted in the Department of ENT, Father Muller Medical College, Mangalore, Karnataka, India between 1^st October 2023 and 31st October 2025, involving 40 patients who presented with thyroid swellings and underwent preoperative FNAC followed by total thyroidectomy. Cytological results were classified utilizing the updated 2023 (3^rd Edition) Bethesda system for reporting thyroid cytopathology. The FNAC findings were correlated with postoperative histopathological reports to determine sensitivity, specificity, predictive values, and accuracy.

Results: Out of 40 thyroid swellings, Colloid nodular goitre was the most frequent condition on fine needle aspiration cytology (FNAC) (72.5%). Under the updated 2023 Bethesda system, 80% of cases were categorized as benign (Category II), with 5% demonstrating atypia of undetermined significance (AUS) (category III). Histopathology confirmed colloid nodular goitre in 60% and malignancy in 5% of cases. FNAC-histopathology correlation showed high concordance, demonstrating excellent diagnostic accuracy for benign and malignant lesions, with a sensitivity of 100%, specificity of 88.89%, positive predictive value of 96.88%, negative predictive value of 100%, and an overall diagnostic accuracy of 97.5%.

Conclusions: FNAC is an essential first-line diagnostic tool for the preoperative evaluation of thyroid swellings, guiding surgical planning with high sensitivity and specificity. However, isolated false-positive interpretations highlight the inherent limitations of standard cytomorphology, underscoring the future necessity of integrating emerging molecular classifiers and AI-driven digital pathology to optimize the management of indeterminate nodules.

A comparative study of complete removal of medial wall of lacrimal sac against mucosal flap technique in endoscopic endonasal dacryocystorhinostomy

2026-07-23T20:00:34+0530

Background: Dacryocystorhinostomy (DCR) is the standard surgical treatment for nasolacrimal duct obstruction (NLDO), creating a fistulous tract between the lacrimal sac and the nasal cavity to relieve epiphora. While considerable literature exists comparing external DCR with endoscopic endonasal DCR, there are few comparative studies evaluating the outcomes of endoscopic endonasal DCR with mucosal flap preservation versus complete removal of the medial wall of the lacrimal sac.

Methods: This was a single-center, prospective, comparative study conducted at the Department of ENT, BJMC and Sassoon Hospital, Pune, Maharashtra, India, from June 2019 to December 2020. Fifty patients with nasolacrimal duct obstruction were allocated into two groups of 25 each: Group A (complete removal of medial wall of lacrimal sac) and Group B (mucosal flap technique). Lacrimal system patency was assessed at three and six months postoperatively using the sac syringing technique.

Results: Surgical success at six months was 100% in Group B versus 92% in Group A, though this difference was not statistically significant (p=0.490). There was no significant difference in postoperative pain scores between the groups (p=0.810). Ostium size shrinkage was 21.3% in Group A and 15.8% in Group B (p=0.157). Early and late postoperative complications, including granulation tissue formation and synechiae, were relatively higher in Group A.

Conclusions: Mucosal flap technique and complete excision of the medial wall of the lacrimal sac in endoscopic endonasal DCR demonstrate comparable outcomes. Although statistically insignificant, the mucosal flap technique showed lower complication rates and less ostium shrinkage.

Digital therapeutics for tinnitus in emerging markets: a content analysis and quality assessment using the mobile app rating scale

2026-07-23T20:00:30+0530

Background: Chronic subjective tinnitus remains a significant clinical challenge globally, characterized by the phantom perception of sound in the absence of external stimuli. While its etiology is multifactorial, the transition from acute perception to chronic distress is increasingly understood through the lens of maladaptive neuroplasticity and increased central gain.

Methods: A systematic prospective analysis and quality assessment were conducted on ten leading mHealth applications. Evaluation was performed using the 23-item Mobile app rating scale (MARS), which provides an objective framework across four objective subscales: engagement, functionality, aesthetics, and information quality, alongside a subjective quality subscale.

Results: The assessment revealed a highly capable but subscription-heavy landscape. Inter-rater reliability was strong (κ=0.86). Oto achieved the highest overall MARS score (4.52), followed closely by MindEar (4.43) and Tinnitus Pro (4.33). While apps like myNoise led in technical functionality (4.8), others like T-minus excelled in visual aesthetics (4.9). Clinical data integrated into the reviews highlighted that AI-driven interventions, such as MindEar, can result in significant reductions in Tinnitus functional index (TFI) scores for 64% of users.

Conclusions: Digital therapeutics offer transformative potential for tinnitus habituation through cognitive behavioral therapy (CBT), sound enrichment, and AI-driven coaching. However, significant socio-technical barriers persist in rural Indian contexts, particularly within the Karnataka region, including linguistic limitations and low digital literacy among seniors. Future adoption in emerging markets requires integrating mHealth into the primary health center (PHC) framework and utilizing community health workers (CHWs) as digital mediators.

Otorhinolaryngological manifestations in patients with hypothyroidism: a cross-sectional observational study

2026-07-23T20:01:45+0530

Background: Hypothyroidism is a common endocrine disorder that frequently manifests with symptoms affecting the otorhinolaryngological (ENT) system. These symptoms are often under-recognized or misdiagnosed, leading to delayed management. This study aimed to evaluate the prevalence and types of ENT symptoms in patients with hypothyroidism and correlate these findings with thyroid hormone levels.

Methods: A cross-sectional observational study was conducted in a tertiary care centre over 8 months, enrolling 200 adult patients diagnosed with primary hypothyroidism. Detailed ENT history and clinical evaluation were performed. Investigations included thyroid function tests, pure tone audiometry for patients with hearing complaints, and laryngoscopy for those with voice changes. Patients were categorized based on TSH levels into mild (4.5–10 mIU/l), moderate (10–20 mIU/l), and severe (>20 mIU/l) hypothyroidism.

Results: Among 200 participants (mean age: 42.5±12.1 years; 70% female), 72% reported at least one ENT symptom. Hoarseness of voice (46.5%), nasal congestion (39%), and hearing loss (36%) were most common. Audiometry revealed sensorineural hearing loss in 62.9% and conductive loss in 37.1% of symptomatic patients. Laryngoscopic evaluation showed vocal cord edema in 72.3% cases. ENT symptom prevalence increased significantly with higher TSH levels (p<0.001).

Conclusions: ENT manifestations are prevalent in hypothyroidism and correlate with disease severity. Early ENT evaluation and thyroid function testing can facilitate timely diagnosis and improve quality of life.

Factual accuracy versus the health literacy barrier: a blinded neurotological assessment of ChatGPT in vertigo education

2026-07-23T20:00:28+0530

Background: Patients increasingly utilize artificial intelligence (AI) models like ChatGPT to seek medical information regarding complex symptoms such as vertigo. The reliability of these AI platforms in providing accurate, comprehensible, and safe clinical information remains a subject of ongoing investigation. Objectives were to evaluate the clinical accuracy, comprehensiveness, and readability of ChatGPT’s responses to common patient inquiries regarding vertigo and vestibular disorders.

Methods: Fifty frequently asked questions (FAQs) concerning vertigo were curated from high-traffic patient forums, clinical encounters, and search engine trends. These questions were categorized into four domains: Diagnosis, treatment, home exercises/lifestyle, and prognosis. The FAQs were inputted into ChatGPT-4. Responses were independently evaluated using a 5-point Likert scale for accuracy and comprehensiveness. Readability was assessed using the Flesch-Kincaid grade level (FKGL) and Flesch reading ease (FRE) scores.

Results: ChatGPT demonstrated high overall accuracy (mean score 4.38±0.62) and comprehensiveness (4.21±0.74). The model performed best in the home exercises/lifestyle category (accuracy 4.65±0.45) and scored lowest in the diagnosis domain (accuracy 4.05±0.82), where it occasionally failed to distinguish atypical features of central vs. peripheral vertigo. The mean FKGL was 12.4±1.8, and the mean FRE was 41.2±10.5, indicating a reading level appropriate for college students but potentially difficult for the general public.

Conclusions: ChatGPT-4 generates highly accurate and comprehensive answers to common patient questions about vertigo, making it a valuable supplementary educational tool. However, its sophisticated vocabulary and occasional diagnostic ambiguity emphasize the necessity for physician oversight.

Evaluation of metastatic cervical lymph nodes by clinical examination, ultrasonography and diffusion weighted MRI in patient of head and neck squamous cell carcinoma: a prospective study

2026-07-23T20:01:29+0530

Background: Accurate evaluation of cervical lymph node metastasis is essential for staging and management of head and neck cancers. Clinical examination has limited sensitivity in detecting occult disease. Ultrasonography improves assessment through morphological and vascular evaluation, while diffusion-weighted magnetic resonance imaging provides functional information based on tissue cellularity. This study aimed to compare the diagnostic performance of these three modalities.

Methods: This prospective observational study was conducted on 50 patients with histopathologically confirmed head and neck carcinoma over a period of 18 months. All patients underwent systematic evaluation using clinical examination, ultrasonography, and diffusion-weighted MRI for assessment of cervical lymph nodes. The diagnostic sensitivity of each modality was determined, and apparent diffusion coefficient (ADC) values were quantitatively analyzed.

Results: In this study, the mean age was 54.18±12.16 years, with a male predominance of 44 patients (88%). The most common primary site was the border of tongue in 10 patients (20%). Tobacco use, either alone or in combination with smoking, was the most common risk factor observed. Level II nodes were most frequently involved 89%. The sensitivity of clinical examination, USG, and DW-MRI was 76%, 86%, and 98% respectively. On ultrasonography, loss of fatty hilum was observed in 95% and intranodal necrosis in 93%. DW-MRI demonstrated diffusion restriction in 98%. The mean ADC value was 0.918±0.077×10⁻³ mm²/s, which was statistically significant (p<0.001).

Conclusions: DW-MRI demonstrated the highest sensitivity among the evaluated modalities. A combined approach improves detection of metastatic and occult cervical lymph nodes, thereby enhancing diagnostic accuracy.

Comparative efficacy of olfactory training versus combination therapy with oral corticosteroids in COVID-19 associated post-viral olfactory dysfunction

2026-07-23T20:00:27+0530

Background: Post-viral olfactory dysfunction (PVOD) has emerged as a critical public health concern, amplified exponentially by the COVID-19 pandemic. While olfactory training (OT) is the current gold standard for rehabilitation, the additive role of systemic corticosteroids remains controversial, particularly for patients presenting late. This study aimed to compare the efficacy of classical OT alone versus a combination of oral corticosteroids and OT in patients with persistent PVOD.

Methods: A prospective cohort study was conducted at the Department of Otorhinolaryngology in a tertiary care hospital in Mangalore between January 2021 and December 2023. We prospectively enrolled and analyzed 142 patients diagnosed with PVOD lasting >4 weeks. Group A received classical OT alone (n=72), and group B received a 14-day tapering course of oral corticosteroids combined with OT (n=70). Olfactory function was assessed using the "Sniffin’ sticks" test (TDI score) at baseline and 12 weeks post-treatment.

Results: Both groups showed significant improvement in TDI scores (p<0.001). Group A improved from a mean baseline TDI of 16.4±4.2 to 21.8±5.1. Group B improved from 15.9±3.8 to 24.1±4.9. Inter-group comparison revealed a statistically significant greater improvement in group B (Combination Therapy) compared to group A (OT alone) (p=0.03). Clinically significant improvement (increase in TDI ≥5.5) was observed in 34.7% of group A and 48.5% of group B.

Conclusions: While OT remains the cornerstone of therapy, a short course of oral corticosteroids in the persistent phase of PVOD offers significant synergistic benefits. This combination mitigates local neuroinflammation and yields superior olfactory recovery scores, even in sub-acute presentations.