International Journal of Otorhinolaryngology and Head and Neck Surgery

A study of oral cavity lesions in a tertiary care industrial hospital

Soumick Ranjan Sahoo — 2025-11-25

Oral cavity lesions can be classified as non-malignant, premalignant and malignant lesions. Diagnosis is confirmed and established by clinical evaluation, biopsy and histopathology. Very few studies have been reported in industrial hospitals. The main aim of the study was to report the various non-malignant, premalignant and malignant oral lesions in our setup. It was a retrospective study conducted at IISCO Steel Plant, Burnpur Hospital. Data of oral lesion patients in whom biopsies conducted followed by histopathology were collected from the hospital records. Various non-malignant lesions, premalignant lesions such as leukoplakia, malignancies such as squamous cell carcinoma were reported. Most of the cases of malignancy and premalignant lesions had tobacco usage which is an occupational hazard at workplace described in literature. Few cases of premalignant lesion and malignancy had negative history of tobacco consumption. It was concluded that early diagnosis helps in accurate treatment of oral cavity lesion and secondly in premalignant oral lesions associated with tobacco usage after confirmation of diagnosis and subsequent behavioural counselling patient compliance in tobacco cessation improves.

Schwannoma of the nasal columella: a rare presentation and surgical management through open rhinoplasty

María Y. O. Suárez — 2025-11-25

Schwannomas are rare benign tumors arising from Schwann cells, with infrequent occurrence in the nasal cavity and paranasal sinuses. Even more uncommon is their presence in the nasal columella, where only a few cases have been reported. We report the case of a 64-year-old female presenting with a slow- growing, firm, non-tender mass in the left nasal vestibule, arising from the membranous septum. The lesion measured 1.5×1.2 cm, causing partial nasal obstruction. The patient had a complex oncological history, including treated breast cancer and suspected CNS metastases. Computed tomography (CT) imaging revealed a well-defined hypodense mass at area I of Cottle. Complete surgical excision was performed via open rhinoplasty, allowing optimal access and aesthetic preservation. Histopathology revealed Verocay bodies in Antoni A pattern. Immunohistochemical staining was positive for S-100 and vimentin, confirming the diagnosis of schwannoma. Postoperative recovery was uneventful. This case highlights a rare location of sinonasal schwannoma and supports open rhinoplasty as an effective approach for diagnosis and treatment, providing both functional and cosmetic benefits.

How rare is too rare to suspect? A case of a well-differentiated liposarcoma of the piriform recess of the larynx

Kallia Erodotou — 2025-11-25

Liposarcomas are among the rarest soft tissue sarcomas in the larynx, accounting for less than 1% of cases with the piriform recess of the larynx being one of the least common sites. These tumors present significant diagnostic delays due to their comparison to benign lipoma lesions. The aim is to emphasize the diagnostic utility of molecular markers such as murine double minute 2 (MDM2) and cyclin-dependent kinase 4 (CDK4), and the importance of maintaining long-term surveillance in patients with atypical adipocytic tumors in the head and neck region. A 56-year-old female with a prior history of hypopharyngeal lipoma presented with progressive dysphagia, hoarseness, and inspiratory stridor. Flexible endoscopic examination revealed a well-circumscribed mass originating from the right piriform recess. Magnetic resonance imaging (MRI) was performed. Initial transoral excision confirmed well-differentiated liposarcoma (WDL) via histopathological analysis and positive MDM2 and CDK4 immunochemistry, further supported by FISH. Following multidisciplinary evaluation in sarcoma tumor board, a second, wide-field excision with clear margins was performed using CO₂ transoral laser microsurgery (TOLMS). Postoperative recovery was complicated by dysphagia. At 24-month follow up, the patient remained clinically disease-free with preserved speech and swallowing functions following dedicated rehabilitative therapy. Involvement of the piriform recess, confirmed by MDM2 and CDK4 gene amplification, and the successful management through CO₂-TOLMS features both the diagnostic complexity and the therapeutic significance of prompt, molecular guided intervention in this rare clinical context. Complete surgical excision with negative margins remains the therapeutic mainstay. Long-term clinical surveillance is essential due to the risk of recurrence and the anatomic complexity of the laryngeal region.

Relapsing polychondritis: a case report

Tedi Minarolli — 2025-11-25

Relapsing polychondritis (RP) is an immune-mediated systemic disease characterized by recurrent attacks of inflammation of cartilage and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment in the affected areas. It may for a long time cause unspecific signs,which may cause a significant delay in establishing the diagnosis and initiating the right treatment. We present the case of a 49 year old male who came to our clinic with a two month history of worsening pain, swelling, and erythema of his left ear auricle. He reported tenderness and warmth over the pinna, along with fever and malaise. The patient was diagnosed with RP and started steroids which are the first choice of therapy. The aim of this case is to emphasize the critical need for timely identification of RP in order to start the appropriate treatment and prevent future complications.

Dilemma in management of spontaneous neck hematoma

Vaishali Agarwal — 2025-11-25

Spontaneous neck hematoma is a rare but potentially life-threatening condition due to its risk of rapid airway compromise. It is most commonly associated with aneurysm, infection, thyroid or parathyroid tumors, or underlying coagulopathy, and may also occur in patients receiving anticoagulation or thrombolytic therapy. We report the case of an 87-year-old male with massive pulmonary embolism and deep vein thrombosis who developed a spontaneous cervical hematoma following catheter-directed thrombolysis with alteplase and systemic heparin. The patient presented with progressive neck swelling, ecchymosis, and airway deviation confirmed by contrast-enhanced computed tomography (CT) and flexible fiberoptic laryngoscopy. Airway protection was achieved with endotracheal intubation, and anticoagulation was withheld. He was managed conservatively with intravenous steroids and antibiotics. Extubation was carefully planned using cuff-leak testing, which was successful without the need for surgical intervention. The hematoma resolved gradually, and the patient recovered fully. This case underscores the importance of early recognition, multidisciplinary decision-making, and individualized airway management strategies in optimizing outcomes for spontaneous neck hematoma, especially in anticoagulated patients.

Nasal skin papilloma mimicking a cutaneous horn in an infant

Aarnav Goyal — 2025-10-01

A cutaneous horn is a hyperkeratotic projection whose clinical significance lies in its underlying epidermal pathology, which can range from benign to premalignant or malignant. While typically seen in sun exposed areas of elderly patients, this report details a rare presentation in an infant where the lesion clinically mimicked a cutaneous horn but was histopathologically identified as a benign skin papilloma. An 11-month-old male infant presented with a keratotic projection on the dorsum of his nose, present since early infancy. Clinical examination revealed a hard, conical mass resembling a cutaneous horn. The lesion was successfully excised under general anesthesia with primary wound closure. The post-operative period was uneventful. Histopathological examination revealed the lesion to be a benign skin papilloma. This case highlights the unusual presentation of a benign skin papilloma mimicking a cutaneous horn in a pediatric patient. It emphasizes that despite rarity in this demographic, thorough evaluation and surgical excision are crucial for definitive diagnosis and treatment, ensuring appropriate management and ruling out any potential underlying malignancy.

Dermatofibrosarcoma protuberans mimicking a benign lesion: case report on a rare diagnostic dilemma

Girish Mishra — 2025-11-25

Dermatofibrosarcoma protuberans (DFSP) is a rare, low- to intermediate-grade dermal sarcoma, representing less than 1% of head and neck malignancies. It is locally aggressive, with high recurrence rates but low metastatic potential. Parotid region involvement is exceptionally uncommon. A 35-year-old male presented with a recurrent swelling in the left pre-auricular region, one month after superficial parotidectomy. Histopathology of the earlier specimen had confirmed DFSP. Positron emission tomography (PET) revealed fluorodeoxyglucose (FDG)-avid nodular enhancement, and wide local excision (WLE) with reconstruction was performed. Margins were clear, and adjuvant radiotherapy was administered. DFSP in the parotid region is extremely rare and may mimic benign parotid tumors, leading to delayed or incorrect diagnosis. Complete surgical excision with negative margins remains the cornerstone of management, while radiotherapy can reduce recurrence risk in high-risk cases. Given its infiltrative nature and propensity for late recurrence, meticulous long-term follow-up is mandatory to ensure optimal outcomes.

Odontogenic keratocyst: wolf in a sheep’s coat

Cherry Anilkumaar Roy — 2025-11-25

Odontogenic keratocyst (OKC) is a benign yet locally aggressive odontogenic lesion with a high recurrence rate. Although more commonly found in the mandible, OKCs may rarely involve the maxilla, posing diagnostic and surgical challenges. We report the case of a 65-year-old female with a recurrent, painful swelling in the upper gingiva, radiologically presenting as a well-defined expansile lytic lesion in the maxilla. The cyst was surgically enucleated under general anesthesia, and histopathology confirmed the diagnosis of odontogenic keratocyst. The patient remained asymptomatic with no recurrence at five months follow-up. This case highlights the need for awareness of atypical presentations of OKC, the importance of histopathological confirmation, and the role of long-term follow-up to monitor for recurrence or malignant transformation.

Coblator-assisted excision of a large vallecular cyst in an adult: a case report

Vaishali Agarwal — 2025-11-25

Vallecular cysts are rare, mucus-retention cysts located at the base of the tongue or lingual surface of the epiglottis. While often asymptomatic in adults, large cysts may lead to dysphagia and voice changes. Authors report a case of a 30-year-old male who presented with progressive dysphagia and voice change. Flexible laryngoscopy and contrast-enhanced CT revealed a large vallecular cyst extending from the base of the tongue to the epiglottis. The cyst was excised completely using a co-ablator in an atraumatic manner. The procedure was uneventful, and the patient was discharged the following day. Vallecular cysts in adults may present with vague symptoms. Co-ablator-assisted excision offers a safe, effective, and minimally traumatic method for complete cyst removal with good outcomes.

Retropharyngeal lipoma as a treatable cause of severe obstructive sleep apnea in a middle-aged male

Sugandha Singh — 2025-11-25

Authors present the rare case of a 38-year-old male with severe obstructive sleep apnea (OSA) caused by a large retropharyngeal lipoma. The patient, previously reliant on continuous positive airway pressure (CPAP) therapy for over eight years, presented with persistent snoring, daytime fatigue and a posterior pharyngeal bulge on clinical examination. Imaging confirmed a retropharyngeal lipoma compressing the airway, extending from the clivus to C6 vertebra. A combined transoral and transcervical surgical excision was performed, achieving complete tumor removal and resolution of OSA symptoms. Postoperative recovery was uneventful, with no recurrence or further need for CPAP. This case underscores the importance of thorough evaluation and imaging in patients with unexplained OSA to identify rare causes such as deep neck space lipomas. Surgical excision remains the definitive treatment, offering excellent outcomes and significantly improving quality of life.

Double-coin foreign body in the oesophagus mimicking a button battery: a report of two cases with literature review

Priyanka Sharma — 2025-11-25

Ingestion of foreign bodies remains a common pediatric emergency, with coins being the most frequent culprit. However, the radio graphic appearance of stacked coins can closely resemble a button battery, a dangerous foreign body that requires emergent removal due to its potential for rapid esophageal injury. Authors report two pediatric patients who presented with suspected button battery ingestion but were intra-operatively found to have ingested two stacked coins. This article reviews their presentations, radio graphic findings, surgical management, and the critical importance of maintaining a high index of suspicion. A literature review highlights the challenges of radiologic differentiation and supports emergent esophagoscopy as the diagnostic and therapeutic gold standard.

Lingual schwannoma of submandibular region - a unique case in a rare location: a case report and literature review

Sunakshi Seigell — 2025-11-25

Schwannomas are uncommon benign nerve sheath tumors that rarely arise in the oral cavity. Among those found in the oral cavity, tongue is the predominant site of involvement. Lingual schwannomas originating in the submandibular region are exceptionally rare and pose a challenge in diagnosis owing to their nonspecific presentation and resemblance to salivary gland pathologies. Authors report the case of a 15-year-old girl presenting with a two-year history of a painless, progressively enlarging swelling in the left submandibular region, initially suspected to be a submandibular gland lesion. Radiological evaluation with ultrasonography and contrast-enhanced MRI demonstrated a well-defined, lobulated mass adjacent to the gland. The patient underwent surgical excision via a transcervical approach, that revealed the tumor arising from the lingual nerve near the submandibular ganglion. Histopathological examination confirmed the diagnosis of schwannoma, characterized by biphasic Antoni A and Antoni B areas with nuclear palisading. A literature review revealed 125 reported cases of lingual schwannomas, with no gender predilection and a wide age range. Given their infrequent and varied clinical presentation, it is emphasized that lingual schwannomas be considered in the differential diagnosis of submandibular and tongue-associated swellings. Complete surgical excision remains the treatment of choice and offers an excellent prognosis with minimal recurrence risk.

Endoscopic adenoidectomy in a 13-month-old child with failure to thrive: a case report

Vaishali Agarwal — 2025-11-25

Adenoid hypertrophy is a common cause of upper airway obstruction in infants and toddlers. When severe, it can cause significant symptoms such as nasal obstruction, feeding difficulties, failure to thrive and sleep disturbances. Timely surgical intervention is crucial for symptom resolution and optimal growth. A 13-month-old male presented with breathing difficulty, mouth breathing, snoring and difficulty in feeding. Clinical examination revealed suprasternal and intercostal retractions. A lateral nasopharyngeal radiograph showed significant adenoid hypertrophy, which was confirmed as Grade 4 on nasal endoscopy. The child underwent endoscopic adenoidectomy under general anesthesia. Postoperatively, there was marked improvement in respiratory and feeding symptoms. At three-month follow-up, the child had gained 2 kg, with no recurrence of symptoms, indicating a successful outcome. Endoscopic adenoidectomy in infants with significant adenoid hypertrophy is a safe and effective intervention. It improves airway patency, feeding and growth and should be considered in severe symptomatic cases even at a younger age.

Ayurvedic management of vocal cord growth: a non-invasive case study

Manisha Singla — 2025-11-25

Vocal cord growth can be differentiated into polyps, nodules, granulomas, and papillomas, which are benign in nature and can cause hoarseness and breathy voice. Laryngeal microsurgery is the most common conventional treatment. However, it is necessary to explore non-invasive treatment options. Objective was to report the outcome of Ayurvedic therapy in a 71-year-old female with a vocal cord growth who declined surgery. The patient presented with hoarseness of voice, vocal fatigue, and globus sensation for one month. Laryngoscopy revealed a right vocal cord growth. Patient was advised MLS under GA by an ENT expert. However, because of anxiety regarding invasive treatment, the patient wanted to explore Ayurvedic treatment options. She was treated with Lavangadi Vati, Gandamala khandan ras, marma gutika lepa, and lifestyle modifications. Significant symptomatic relief was observed within one week, with complete resolution confirmed by laryngoscopy at six weeks and sustained at follow-up. The GRBAS score improved from severe to normal in four weeks. This case suggests that Ayurvedic management may offer a non-invasive alternative solution for vocal cord growth, meriting further research.

Vagal schwannoma mimicking carotid body tumour treated by intracapsular excision: a case report

Khushbu Solanki — 2025-11-25

Vagal schwannomas are rare benign neurogenic tumours of the head and neck that may closely mimic carotid body tumours (CBTs) on clinical and radiological evaluation. Differentiating the two entities is essential to optimize surgical planning, preserve neural function, and prevent unnecessary morbidity. We present the case of a 23-year-old female with a slowly enlarging, non-pulsatile left neck swelling in the carotid triangle. Clinical examination and magnetic resonance imaging (MRI) suggested a carotid space lesion displacing the common carotid artery anteromedially and internal jugular vein posterolaterally. Preoperative biochemical screening for catecholamine excess was negative. The lesion was excised via a transcervical approach using intracapsular enucleation, with careful preservation of vagal nerve fibres. Intraoperative findings confirmed an encapsulated spindle-shaped tumour arising from the vagus nerve. Histopathology revealed Antoni A and Antoni B areas with Verocay bodies, strongly positive for S-100 protein, consistent with schwannoma. Postoperative recovery was uneventful, with preserved vocal cord mobility and no features of Horner’s syndrome. At 12-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the diagnostic challenge of differentiating vagal schwannomas from CBTs. MRI vascular displacement patterns-anteromedial displacement of the carotid artery and posterolateral displacement of the IJV-are key imaging clues. Intracapsular excision offers the advantage of neural preservation with low recurrence risk when combined with meticulous dissection and long-term follow-up.

Beyond the sinus: orbital extension of acute bacterial rhinosinusitis – a case report and literature review

Girish Mishra — 2025-11-25

Orbital complications of acute rhinosinusitis (ARS) are rare but potentially life-threatening, particularly in children. Due to anatomical factors such as thinner bony partitions, increased vascularity, and underdeveloped sinuses, children are more vulnerable to orbital extension of sinonasal infections. Early diagnosis and prompt management are crucial to prevent severe outcomes including vision loss or intracranial spread. We report a case of 4 year old boy presenting with fever, periorbital swelling, and headache secondary to ARS, imaging with contrast-enhanced CT (CECT) scan, successfully managed with endoscopic drainage and medical therapy. Early diagnosis and prompt management are critical in paediatric ARS to prevent vision-threatening or life-threatening complications. A multidisciplinary approach, imaging, targeted antibiotic therapy, and timely surgical intervention contribute to improved outcome. Prompt recognition and combined medical-surgical treatment of orbital complications in paediatric ARS are essential for a favourable prognosis.

Post-tonsillectomy hemorrhage due to pseudo-aneurysm of the facial and lingual arteries successfully managed by multidisciplinary approach: a case report

Vaishali Agarwal — 2025-11-25

Post-tonsillectomy hemorrhage (PTH) is a potentially life-threatening complication, often arising from arterial injury. We report a rare case of massive bleeding from the left tonsillar fossa following tonsillectomy in an 18-year-old male, secondary to a pseudo-aneurysm involving the lingual and facial arteries. The patient was successfully managed with endovascular covered graft placement due to the presence of an Aberrant ophthalmic artery, which precluded embolization. This case highlights the importance of early recognition of vascular injuries and individualized endovascular strategies in managing severe oronasal hemorrhage.

Autologous activated platelet-rich plasma gel as a sole adjunct in endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea: a case series

Vijayasundaram Sundararajan — 2025-11-25

Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication between the subarachnoid space and the nasal cavity, predisposing patients to potentially life-threatening meningitis if not promptly treated. Endoscopic endonasal repair has become the standard of care, with surgical success depending on precise localisation of the defect, secure multilayer closure, and the use of effective adjuncts. Platelet-rich plasma (PRP), when activated with calcium chloride to form a gel, provides a concentrated source of growth factors that enhance healing, promote rapid mucosal regeneration, and create an immediate watertight seal, offering an autologous, economical alternative to commercial fibrin sealants. This retrospective case series from a tertiary care centre in Pondicherry included five female patients aged 43-50 years who presented with spontaneous CSF rhinorrhea without any preceding trauma, surgery, or obvious precipitating factors. CT cisternography and MRI were used to localise defects, and two patients demonstrated features suggestive of idiopathic intracranial hypertension. All patients underwent endoscopic multilayer repair using fat and fascia lata grafts, with PRP gel-prepared by activating autologous PRP with calcium chloride-applied between graft layers and externally over the reconstruction site. Postoperative management included antibiotics, acetazolamide, and lumbar drainage when indicated. All five patients achieved complete resolution with no recurrence, meningitis, graft failure, or other complications during six months of follow-up. Activated PRP gel proved to be a safe, effective, and cost-efficient adjunct for reinforcing endoscopic anterior skull base CSF leak repair, although larger studies are required to validate long-term outcomes.

Neutrophil percentage-to-albumin ratio: is it useful in oropharyngeal cancer?

Mónica Teixeira — 2025-11-25

Background: Host determinants, including nutritional status and systemic inflammation, are critical in the body's response to cancer. Neutrophil percentage-to-albumin ratio (NPAR) has emerged as a promising prognostic marker, however, its significance in head and neck cancer has yet to be fully established. This study aims to evaluate pretreatment NPAR as a predictor of disease-free survival, overall survival and cancer-specific survival in patients with oropharyngeal carcinoma.

Methods: This retrospective cohort study included 88 patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) who underwent curative-intent treatment between January 1, 2010, and January 1, 2023. NPAR levels were assessed between diagnosis and treatment initiation. ROC analysis identified the optimal NPAR cutoff value of 16.09, which was used to categorize patients into low-NPAR and high-NPAR groups.

Results: High NPAR (≥16.09) was significantly associated with tumor persistence or recurrence (OR=5.70; p<0.001). Disease-free survival, 5-year overall survival and 5-year cancer-specific survival were all significantly shorter among patients with NPAR ≥16.09. In fact, high-level NPAR group had over than 3-fold increased risk of cancer-specific death at 5 years (HR=3.440; p=0.006).

Conclusions: Our findings indicate that a NPAR ≥16.09 may be associated with poorer outcomes in oropharyngeal cancer. While NPAR shows potential as a prognostic biomarker to complement the TNM staging system, further validation in larger, prospective studies is warranted.

Incidence and predictors of post-tonsillectomy hemorrhage: a two-year retrospective analysis from a tertiary care center in Qatar

Prakash Obalappa — 2025-11-14

Background: Post-tonsillectomy bleeding (PTB) is one of the most concerning complications following tonsillectomy, with potential implications for patient morbidity and surgical outcomes. This retrospective study aimed to determine the incidence, pattern, and possible demographic risk factors associated with PTB in a tertiary care hospital setting.

Methods: A retrospective review was conducted at Al Ahli Hospital, Doha, Qatar, including 329 patients who underwent tonsillectomy between September 2023 and August 2025. Patients with recurrent chronic tonsillitis or obstructive sleep apnea were included, while those with unilateral tonsillectomy, tonsillar biopsy, or suspected neoplasms were excluded. Data on demographic characteristics, timing of bleeding, and return to the operating room (OR) were analyzed using Fisher’s Exact Test, with p<0.05 considered statistically significant.

Results: The overall incidence of PTB was 4.25%, comprising 0.30% primary and 3.95% secondary hemorrhage. Bleeding was more frequent in males (3.34%) compared to females (0.91%), and a slight increase in bleeding incidence was noted with age (0.91% in <5 years, 1.51% in 5–15 years, and 1.82% in ≥16 years). However, these differences were not statistically significant. Only 1.21% of patients required surgical intervention, and no cases required blood transfusion. Bilateral and contralateral bleeding were rare (0.30% each).

Conclusion: PTB incidence in this cohort was low and predominantly secondary in nature. Although bleeding was more frequent among older and male patients, neither age nor gender significantly influenced the risk of reoperation. Consistent surgical technique and vigilant postoperative monitoring remain critical for minimizing bleeding-related complications.

A comparative study of sodium bicarbonate 5% and carbamide peroxide 6.5% as cerumenolytic agents

Younus Majeed Dar — 2025-10-24

Background: Earwax impaction is common and can cause symptoms such as hearing loss, discomfort, tinnitus, vertigo, and chronic cough. Removing impacted cerumen often improves hearing. Many cerumen-removal products exist but have limited efficacy, often requiring multiple doses over days. Sodium bicarbonate (5%) and carbamide peroxide (6.5%) are two important cerumenolytics. This study aimed to compare their effects on different degrees of wax obstruction.

Methods: This cross-sectional study at a tertiary ENT center included 148 adult patients with ≥50% bilateral ear canal occlusion (grades 3-4). Each patient received 5% sodium bicarbonate drops in one ear and 6.5% carbamide peroxide drops in the other, three times daily for four days. After 4 days, cerumen was removed by syringing and clearance outcomes were compared. Data were analyzed statistically with significance at p≤0.05.

Results: The mean age was 54±12.8 years, with a male predominance. Hearing loss was the most common symptom. Sodium bicarbonate demonstrated significantly more effective cerumen dissolution and clearance than carbamide peroxide (p<0.05). Complete clearance was achieved in 34.3% and 25.0% of ears treated with sodium bicarbonate and carbamide peroxide, respectively. Nearly half of sodium bicarbonate-treated ears (50.5%) were cleared with one syringing attempt, compared to about one-third with carbamide peroxide.

Conclusions: Sodium bicarbonate is a more effective option than carbamide peroxide for treating cerumen impaction in the external ear canal. By reducing blockage and symptoms, its use can improve patients’ quality of life.

Clarithromycin 500 mg extended-release in the management of patients with upper respiratory tract infection: results from a prospective, multicentre, single-arm and post-marketing observational study

Samir Bhargava — 2025-10-24

Background: Upper respiratory tract infections (URTI) are a leading cause of morbidity globally and frequently require antibiotic therapy. Clarithromycin extended-release (ER) formulation is widely used for treating URTI, and may improve adherence, gastrointestinal tolerability and outcomes. This study aimed to evaluate the effectiveness and safety of clarithromycin 500 mg ER in Indian patients with URTI.

Methods: This prospective, multicenter, single-arm, open-label, post-marketing observational study was conducted at six sites in India. Adults (20-70 years) with acute bacterial URTI (otitis media, sinusitis/pharyngotonsillitis) were enrolled. Patients received clarithromycin 500 mg ER once daily for 7 days, followed by a 5-day telephonic follow-up. Clinical improvement by day 7 (±2), changes in clinical symptom scores (CSS), and safety/tolerability were evaluated.

Results: Total of 227 were included in safety analysis set, with a mean (SD) age of 34.35 (11.09) years and a female predominance (129 females, 98 males). By day 7, 82.3% achieved clinical cure and 17.7% showed symptom improvement. Significant mean (SD) CSS reduction of 95.28% (±11.16) was observed (p<0.0001). Curative rates by diagnosis were 88.5% for pharyngotonsillitis, 78.3% for sinusitis, and 66.0% for otitis media. Symptom relief was reported by 76.1% of patients within 3 days. The treatment was well tolerated, and no serious adverse drug reactions (ADRs) were observed.

Conclusions: Clarithromycin 500 mg ER demonstrated high effectiveness and tolerability in treatment of URTI in Indian patients. It’s reassuring safety profile and rapid symptom relief support its use in real-world primary care settings.

Endoscopic dacryocystorhinostomy and outcomes: our experience

Malavika Madathumpadikal — 2025-11-25

Background: Dacrocystorhinostomy can be done by external or by endoscopic approaches. This paper is a series of 33 cases of endoscopic DCR.

Methods: Prospective study of 30 patients who underwent endoscopic DCR from October 2023 to October 2024.

Results: Out of the 30 patients, 26 were females and 4 males. Majority were in the 61-70 age group. Bilateral DCR was done in 3 out of the 30 patients. 18 patients underwent R DCR and 15 patients underwent L DCR. Primary stenting was done in 1 patient. Stenting was done after 2 weeks in view of regurgitation on lacrimal syringing in 3 patients.

Conclusions: Routine primary stenting is not required in endoscopic DCR. Post operative failure could be due to granulation tissue or inadequate bone removal.

Simultaneous bilateral tympanoplasty with or without mastoidectomy

Anita M. Thomas — 2025-11-25

Background: Bilateral simultaneous tympanoplasty with or without mastoidectomy scores over traditional sequential unilateral tympanoplasty with or without mastoidectomy in terms of convenience and cost-effectiveness for the patients with conservation of resources. But it is rarely performed, mainly because of the theoretical risk of iatrogenic sensorineural deafness. The outcomes of bilateral single-stage tympanoplasty with or without mastoidectomy studied are sparse in the literature. Authors intend to evaluate the risks of these procedures in the current era of advanced instrumentation and newer techniques, where the risk of complications is expected to be minimal in experienced hands, and to evaluate our results regarding hearing gain, graft uptake, and complications.

Methods: A total of 23 patients with bilateral central perforation of the tympanic membrane who underwent surgery of both ears simultaneously were retrospectively analysed (January 2017 to November 2023). The results were evaluated regarding graft uptake, hearing gain, and complications like sensorineural hearing loss (SNHL), facial nerve palsy, and chorda tympani nerve damage.

Results: Closure of perforation was successful in 89.1% of patients, and hearing improvement was observed in 95.7%. None of the patients had iatrogenic sensorineural hearing loss or facial nerve palsy. One patient had inadvertent bilateral chorda tympani nerve damage.

Conclusions: Simultaneous bilateral tympanoplasty/tympanomastoidectomy is a convenient, cost-effective procedure for patients with bilateral disease. The risk of SNHL is negligible if cases are chosen appropriately, and it has a similar success rate as a single-stage procedure.

Antibacterial susceptibility profiling of otitis media isolates: a tertiary care centre based retrospective study

Selvi I. — 2025-11-25

Background: Otitis media is an inflammation of the middle ear, posing a significant public health burden across all age groups. Timely identification of causative organisms and their antibiotic susceptibility is essential for effective treatment and for curbing antibiotic resistance.

Objectives: To determine the bacterial profile and antibacterial susceptibility patterns of isolates from otitis media cases in a tertiary care centre.

Methods: A retrospective study was conducted on 576 ear discharge samples from clinically diagnosed otitis media cases between January and December 2024. Standard microbiological techniques were employed for culture and identification. Antibacterial susceptibility testing was performed using the Kirby-Bauer disc diffusion method in accordance with CLSI guidelines.

Results: Of the 576 samples, 385 (66.8%) showed microbial growth, with bacterial isolates identified in 349 (90.6%) samples. Pseudomonas aeruginosa was the predominant organism (50.5%), followed by Staphylococcus aureus (30.4%) and Enterobacterales (15%). The isolates showed varied susceptibility to commonly used antibiotics, with notable resistance to Ciprofloxacin, Amoxicillin-clavulanic acid, and Aminoglycosides.

Conclusion: The findings emphasize seasonal variations and evolving trends in the bacterial aetiology of otitis media and the importance of continuous surveillance of antibacterial susceptibility patterns. These data are essential for guiding and formulating effective antimicrobial stewardship strategies in clinical practice.

Identification of tertiary lymphoid structures in oral squamous cell carcinoma and its clinico-pathological associations

Abhijit Kalita — 2025-11-25

Background: Tertiary lymphoid structures (TLS) are ectopic, vascularised lymphoid structures that may be found in and around tumor tissue. The role of TLS has been studied in few solid tumors in which high TLS expression was found to be favourable prognostic biomarker.

Methods: The present study was a retrospective and prospective study for a period of one year. Resected specimen of Oral squamous cell carcinoma (OSCC) with no history of previous treatment were included. The presence of TLS was assessed in tumor proper, invasive front as well as in adjoining areas of tumor. The association of TLS with size of the tumor, degree of differentiation of the tumor, pattern of invasion/tumor budding, tumor infiltrating lymphocytes (TIL) and lymph node pattern have been studied.

Results: 52 resected specimens of OSCC were evaluated in present study, out of which 24 (46.15%) showed presence of TLS. Amongst the tumor with TLS, 54.16% had size <2 cm, 62.5% were well differentiated carcinoma and 8.3% had worst pattern of invasion. TILs were distributed equally amongst three sites- tumor proper, invasive front and the adjacent tissue, in the TLS positive cases. The lymphocyte predominant pattern of lymph node showed a strong association with the expression of TLS (37.5%).

Conclusions: In the present study, TLS has been found to be associated with positive prognostic factors. Also, it has been found that TLS is not a proxy of the TILs. Identification and evaluation of TLS has a great potential as prognostic marker and needs evaluation.

A study of the clinical profile of patients undergoing tonsillectomy with or without adenoidectomy

Mridima Chandra — 2025-11-25

Background: Tonsillectomy and adenoidectomy are among the most common otorhinolaryngological surgeries, indicated for recurrent tonsillitis, adeno-tonsillar hypertrophy, and obstructive sleep apnoea. Histopathological examination of excised specimens aids in confirming diagnosis and detecting rare pathology.

Methods: A prospective study was conducted at Gujarat Adani Institute of Medical Sciences, Bhuj, from June 2023 to November 2024. Seventy patients undergoing tonsillectomy and/or adenoidectomy were enrolled. Demographic profile, presenting symptoms, Brodsky grading, surgical details, and histopathological findings were analysed. Data were processed using SPSS v25.0.

Results: The majority of patients were adolescents (11-20 years, 37.1%) with a female predominance (55.7%). The predominant symptom was throat pain (95.7%), followed by mouth breathing and snoring (12.9% each). Most patients presented with grade 3 tonsillar hypertrophy (74.3%), and symptoms of 1-3 years’ duration (71.4%). Bilateral tonsillectomy was the most common surgery performed (87.1%). Histopathological findings revealed chronic tonsillitis in 51.4% of cases, followed by chronic tonsillitis with actinomycetes (18.6%) and chronic lymphoid hyperplasia (15.7%). Rare findings included lymphoepithelial cysts (1.4%).

Conclusions: Chronic tonsillitis remains the leading indication for tonsillectomy, with strong correlation between clinical and histopathological features. Early recognition and surgical intervention yield favourable outcomes. Routine histopathology remains indispensable tool in excluding uncommon benign and malignant lesions.