International Journal of Otorhinolaryngology and Head and Neck Surgery https://www.ijorl.com/index.php/ijorl <p>International Journal of Otorhinolaryngology and Head and Neck Surgery is an open access, international, peer-reviewed journal that publishes original research articles, review articles, and case reports in all areas of otorhinolaryngology. The journal's full text is available online at https://www.ijorl.com. The journal allows free access to its contents. International Journal of Otorhinolaryngology and Head and Neck Surgery is dedicated to bringing otorhinolaryngologists community around the world the best research and key information. The journal has a broad coverage of relevant topics in Otorhinolaryngology and various subspecialties such as Otology, Rhinology, Laryngology and Phonosurgery, Neurotology, Head and Neck Surgery etc. International Journal of Otorhinolaryngology and Head and Neck Surgery is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new surgical techniques. It is published every <strong>two months</strong> and available in print and online version. International Journal of Otorhinolaryngology and Head and Neck Surgery complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email:</strong> <a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a>, <a href="mailto:editor@ijorl.com" target="_blank" rel="noopener">editor@ijorl.com</a></p> <p><strong>Print ISSN:</strong> 2454-5929</p> <p><strong>Online ISSN:</strong> 2454-5937</p> <p><strong>Publisher:</strong> <a href="http://www.medipacademy.com" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix: 10.18203</strong></p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="http://www.crossref.org" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Otorhinolaryngology and Head and Neck Surgery accepts manuscript submissions through <a href="https://www.ijorl.com//index.php/ijorl/about/submissions#onlineSubmissions" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>About the Journal &gt; <a title="Online Submissions" href="https://www.ijorl.com/index.php/ijorl/about/submissions#onlineSubmissions" target="_blank" rel="noopener">Online Submissions</a></p> <p>Registration and login are required to submit items online and to check the status of current submissions.</p> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="https://youtu.be/YHX7eUWH7bk" target="_blank" rel="noopener">https://youtu.be/YHX7eUWH7bk</a></p> <p>Problem Logging In-Clear cookies:<br /><a href="https://youtu.be/WVjZVkjB2SQ" target="_blank" rel="noopener">https://youtu.be/WVjZVkjB2SQ</a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="mailto:medipeditor@gmail.com" target="_blank" rel="noopener">medipeditor@gmail.com</a>, <a href="mailto:editor@ijorl.com">editor@ijorl.com</a></p> <p> </p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Otorhinolaryngol Head Neck Surg.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The journal is indexed with</p> <p><strong><a href="https://journals.indexcopernicus.com/search/journal/issue?issueId=all&amp;journalId=43336" target="_blank" rel="noopener">Index Copernicus</a>, </strong></p> <p><a title="https://www.scilit.net/wcg/container_group/5887" href="https://www.scilit.net/wcg/container_group/5887" target="_blank" rel="noopener"><strong>Scilit (MDPI)</strong></a></p> <p><a href="http://www.crossref.org/titleList/" target="_blank" rel="noopener">CrossRef</a>,</p> <p><a title="LOCKSS" href="http://localhost/index.php/ijorl/gateway/lockss" target="_blank" rel="noopener">LOCKSS</a>, </p> <p><a href="https://scholar.google.co.in/" target="_blank" rel="noopener">Google Scholar</a>, </p> <p><a href="http://jgateplus.com/search/login/" target="_blank" rel="noopener">J-Gate</a>,</p> <p><a href="http://www.sherpa.ac.uk/romeo/search.php?id=2295&amp;format=full&amp;fIDnum=%7c" target="_blank" rel="noopener">SHERPA/RoMEO</a>,</p> <p><a href="http://www.icmje.org/journals-following-the-icmje-recommendations/" target="_blank" rel="noopener">ICMJE</a>, </p> <p><strong><a href="http://www.journaltocs.ac.uk/index.php?action=browse&amp;subAction=pub&amp;publisherID=3072&amp;journalID=35409&amp;pageb=1&amp;userQueryID=25467&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" target="_blank" rel="noopener">JournalTOCs</a> </strong></p> <p><a href="http://journalseeker.researchbib.com/view/issn/2454-5929" target="_blank" rel="noopener">ResearchBib</a>.</p> Medip Academy en-US International Journal of Otorhinolaryngology and Head and Neck Surgery 2454-5929 An overview on the role of epiglottis in obstructive sleep apnoea https://www.ijorl.com/index.php/ijorl/article/view/4235 <p>Obstructive sleep apnoea (OSA) is common sleep disorder with its multimodal effect on health. OSA, if untreated can lead to various cardiovascular, cerebrovascular, psychological, cognitive as well as sexual morbidities. Continuous positive airway pressure (CPAP) device is considered as the gold standard in the treatment of OSA. Epiglottic collapse (EC) in OSA has evolved an important factor in the management of OSA as the CPAP may worsen the sleep apnoea. EC in itself is classified into primary or secondary, partial or complete, anteroposterior or lateral. Epiglottic collapse is considered as one of the causes for poor adherence to CPAP devices. There are newer diagnostic modalities to diagnose and distinguish primary and secondary epiglottic collapse of which interventional drug induced sleep endoscopy plays a viable and important role. CPAP still serves as a primary treatment modality for multilevel OSA with EC. Surgical treatment modalities for EC is aimed at improving the compliance of CPAP as well as for relieving the obstruction. Surgical options primarily include epiglottectomy, glossoepiglottopexy, epiglottis stiffening operations.</p> Vijaya K. Paramasivan Mithra S. John Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 362 368 10.18203/issn.2454-5929.ijohns20241340 A prospective, multicenter study to evaluate the effectiveness and safety of prochlorperazine in patients suffering from vestibular migraine https://www.ijorl.com/index.php/ijorl/article/view/4181 <p><strong>Background: </strong>Prochlorperazine is commonly used for managing vertigo and dizziness-associated vestibular disorders. This study was designed to evaluate the effectiveness and safety of prochlorperazine in Indian patients with vestibular migraine.</p> <p><strong>Methods:</strong> In this prospective, multicenter, open-label, single-arm study, VM patients received 5 mg of prochlorperazine thrice daily for 5 days. The primary endpoint measured changes in clinical response using the scale for vestibular vertigo severity level and clinical response evaluation from baseline to days 6, 15, and 30. Secondary endpoints included symptom severity improvement and changes in SVVSLCRE from baseline up to day 30. Safety and tolerability were also assessed. Statistical analysis used the Wilcoxon signed-rank test and student-paired t-test.</p> <p><strong>Results:</strong> Out of 259 enrolled patients, 254 (98.1%) completed the study with a mean (standard deviation) age of patients was 42.22 (10.7) years; 72.2% were females. Significant improvements in clinical response and symptom severity were observed at all follow-up periods. 81.5% of patients showed VM symptom improvement by day 6, with 77.2% exhibiting moderate to good changes in SVVSLCRE scores. 83.4% experienced milder vestibular symptoms after 6 days. Furthermore, a significant difference (p&lt;0.001) in mean values was observed from baseline at different follow-up periods. 11 (4.3%) adverse events (AEs) were reported, with headache being the most common (2, 0.8%); all AEs were unrelated to the study drug, and patients reported good tolerability.</p> <p><strong>Conclusions: </strong>Prochlorperazine showed significant improvement in clinical response and symptom severity with acceptable safety and tolerability in VM patients.</p> M. Ilambarathi Aditya Yeolekar Dhrubo Roy Savyasachi Saxena Suresh Kumar Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-04-12 2024-04-12 10 3 258 264 10.18203/issn.2454-5929.ijohns20240950 Post-therapeutic detection of local tumor persistence of head and neck cancer: the value of routine control endoscopy with biopsy and medical imaging https://www.ijorl.com/index.php/ijorl/article/view/4252 <p><strong>Background:</strong> Insufficient local tumor control is the main cause of treatment failure in head and neck cancer (HNC). Re-staging HNC is challenging because of post-therapeutic tissue distortion. We investigate whether medical imaging and biopsy is more sensitive in identifying tumor persistence.</p> <p><strong>Methods:</strong> In our clinic a re-staging with a control endoscopy and medical imaging is performed 3 months after therapy for some HNC patients. In this retrospective study, we compare the accuracy of imaging to the histology (gold standard). Imaging reports were classified according to 3 scales and re-assessed by 2 neuroradiologists. Furthermore, we evaluate recurrence rates and disease-free survival. </p> <p><strong>Results:</strong> 100 cases were evaluated. 14 patients presented with positive histology at the re-staging. Biopsy detected malignancy in 7 patients with inconspicuous imaging. Disease-free survival during the first 2 years was generally low (n=55). The accuracy of the RECIST scale was 0.74 with a sensitivity of 0.50 and a specificity of 0.78. Imaging reports reviewed according to the Lee-scale and a self-developed scale presented an accuracy of 0.47 and 0.51. Re-assessment of imaging by 2 neuroradiologists showed an accuracy of 0.87.</p> <p><strong>Conclusions:</strong> Medical imaging alone serves as a moderate diagnostic tool to diagnose local persistence of HNC 3 months after therapy. Radiologic misdiagnosing can be addressed by control endoscopy. Our results indicate a benefit of routine biopsies since reliance on imaging may fail to notice tumor persistence. A binary classification of imaging showed a higher accuracy than conventional imaging scales and may help to predict tumor recurrence within 24 months after re-staging.</p> Tobias Engert Leyla Acu Johann Schoenhofer Nikki Rommers Nader Ahmad Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-04-12 2024-04-12 10 3 265 273 10.18203/issn.2454-5929.ijohns20240951 Association of apnea-hypopnea index and lateral cephalometry pre- and post-surgery in obstructive sleep apnea patients https://www.ijorl.com/index.php/ijorl/article/view/4275 <p><strong>Background:</strong> Snoring and obstructive sleep apnea are new emerging medical entity and require early diagnosis and treatment because of their increasing implication on physical, mental, social and emotional health. Aim of this study is to assess severity of OSHAS and co-relate efficacy of various post-surgical parameter on objective and subjective improvement in patients.</p> <p><strong>Methods:</strong> 43 patients having the symptoms were included in the study and followed over a period of three months and during their post operative visit their lateral cephalometric findings, ESS were recorded and compared to pre operative values to see if any association exists between them.</p> <p><strong>Results:</strong> it was seen that various surgical interventions did bring about subjective and objective improvement in patients and these were statistically significant.</p> <p><strong>Conclusions:</strong> OSHAS is a spectrum of disorders and has great impact on persons physical, mental and emotional well-being. Early diagnose and treatment eliminated the future risks. Surgical intervention helps improve symptoms of OSHAS and should be undertaken without delay wherever indicated.</p> Aswini A. Swati Mishra Devanshi Modi Sanjay Udupi Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-13 2024-05-13 10 3 274 280 10.18203/issn.2454-5929.ijohns20241297 Evaluation and outcome of hearing in meningitis patients https://www.ijorl.com/index.php/ijorl/article/view/4186 <p><strong>Background: </strong>Meningitis remains the most common cause of acquired severe to profound SNHL in childhood. Likewise, deafness is the most common long-term neurological sequelae of the disease. Important consideration following meningitis is the development of labyrinthitis ossificans in which there is new bone formation within the lumen of the otic capsule. Ossification of the labyrinth can develop within a few days of meningitis which can make cochlear implantation difficult. Every newborn should be promptly screened for any hearing deficit along with the patients having meningitis. The most easily available investigation are OAE and BERA.</p> <p><strong>Methods: </strong>Our ambispective study of 25 patients was undertaken in a duration of 2 years in ENT department of civil hospital, Ahmedabad. All the patients underwent a detailed clinical examination and all routine audiological, and radiological investigations.</p> <p><strong>Results: </strong>The prevalence of hearing loss in post meningitis pediatric age group is 40%. Females are affected more than males. Median age group of presentation with hearing deficit is 4 years. Patients with complete immunization history have lower incidence of hearing loss associated with meningitis than incomplete immunization. Ossification of the cochlea can develop as early as 6 days from the development of first symptom.</p> <p><strong>Conclusions: </strong>Ossification of the cochlea can develop as early as 6 days from the development of first symptom. These are the candidates who should be prioritized for cochlear implant surgery. Patients with mild hearing loss recovered completely whereas those with profound hearing loss underwent cochlear implant surgery and were benefited with it.</p> Nandini Gupta Abhishek Khandelwal Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 281 285 10.18203/issn.2454-5929.ijohns20241322 Evaluating the benefits and outcomes of second ear surgeries in bilateral stapedectomies: a comprehensive analysis https://www.ijorl.com/index.php/ijorl/article/view/4241 <p><strong>Background:</strong> Objectives of the study were to evaluate the anatomical abnormalities and benefits of second ear surgery in patients with bilateral otosclerosis undergoing stapedectomy.</p> <p><strong>Methods:</strong> A descriptive retrospective study was done in 43 patients undergoing bilateral stapedotomy in a tertiary care centre. Anatomical abnormalties presenting intraoperative were recorded in both operated ears. Hearing outcomes after the first and second ear surgeries were recorded. Chi square and paired t test was used to find the association between categorical and continuous variables between both groups. We correlated the post-operative air conduction (AC) averages, air bone gap (ABG) gain, AC gain between first and second operated ears. </p> <p><strong>Results:</strong> Obliterative FP was the most common abnormality seen 7%, followed by facial nerve anamolies 5%. Bilateral variations were seen in 66% and 60% respectively. 66% required bilateral drill outs. After 1st ear and 2nd ear surgery 81% and 76% gained normal hearing. Average postop AC threshold was significantly higher after first ear surgery (p&lt;0.001). ABG and AC gain had no significant difference in both ears. Binaural symmetrical hearing with inter aural difference AB&lt;10 dB was achieved in 90% of patients.</p> <p><strong>Conclusions:</strong> It is worthwhile to recommend the patients to undergo contralateral ear surgery if the first ear had achieved normal or socially acceptable hearing, as the chances of achieving a comparable hearing outcome as that of 1st ear is high. Following 2nd ear surgery an effective binaural symmetric hearing can be achieved.</p> Sheetal K. Preethi R. B. A. Abhilash Divya M. B. Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 286 293 10.18203/issn.2454-5929.ijohns20241323 Frequency of lymph node metastasis in differentiated thyroid carcinoma https://www.ijorl.com/index.php/ijorl/article/view/4189 <p><strong>Background:</strong> Although lymphatic metastasis does not affect overall survival for patients with differentiated thyroid carcinoma, locoregional control can be improved with cervical lymphadenectomy. The major morbidity of neck dissection (ND) for the management of regional metastasis is spinal accessory (CN XI) dysfunction. To avoid this complication, some surgeon advocates limited ND. This study aimed to analyze the frequency of lymph node metastasis in differentiated carcinoma of the thyroid.</p> <p><strong>Methods:</strong> This cross-sectional observational study was conducted at the Department of Otolaryngology, Rajshahi Medical College Hospital, Rajshahi, and Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU), from July 2011 to Jun 2012. A total of 40 patients were selected as study subjects by simple random sampling technique. A descriptive analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. </p> <p><strong>Results:</strong> In this study, a majority 35 (87.5%) of the patients suffered from papillary carcinoma, followed by 5 (12.5%) follicular carcinoma It was found that 18 (51.43%) patients had lymph node metastasis from papillary carcinoma of the thyroid. 10 (55.56%), and 4 (22.22%) patients had right and left-sided lymph node involvement respectively. Bilateral involvement was found in 4 (22.22%) patients. The predominant site of metastasis was level-III (77.3%) followed by level-VI (63.64%) nodal metastasis.</p> <p><strong>Conclusions:</strong> This study concludes that metastasis in differentiated thyroid carcinoma is common. Lymph node metastasis is more common in papillary carcinoma than follicular carcinoma.</p> M. Khaled Shahrear Muhammad M. Haque Ashik Iqbal M. Romena Khatun Ali A. M. Nafis Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 294 298 10.18203/issn.2454-5929.ijohns20241324 A comparative study on outcome of endonasal dacryocystorhinostomy with and without silicone intubation-otorhinolaryngology https://www.ijorl.com/index.php/ijorl/article/view/4218 <p><strong>Background: </strong>Epiphora or “tearing eye” is a functionally and socially, bothersome symptom. Dacryocystitis is an inflammatory condition of the nasolacrimal sac caused due to an obstruction within the nasolacrimal duct (NLD). Dacryocystitis can be classified as acute and chronic or acquired and congenital. Chronic dacryocystitis is almost always managed surgically. The present study was undertaken for comparative study of outcomes of endonasal Dacryocystorhinostomy (DCR) done with and without silicone intubation.</p> <p><strong>Methods:</strong> The 50 cases dacryocystitis were selected. The patients were divided in group A cases (with intubation) and group B controls (without intubation) randomly. A detailed history was taken followed by general physical and clinical otorhinolaryngological examination. Patients were evaluated with nasal endoscopy, DCG (Dacrocystogram), through which site of obstruction was located.</p> <p><strong>Results:</strong> In our study, Among the cases 18 subject presented with right dacryocystitis and 7 with left dacryocystitis. Similarly, among the controls, 20 subjects presented with right dacryocystitis and 5 presented with left dacryocystitis. According to modified Likert’s score, at the end of 6 months when a nasal endoscopy was done along with syringing 96% of the cases had patent rhinostomy while only 80% of the controls showed patency. Post operative epistaxis was evident in 6 cases and 4 controls.</p> <p><strong>Conclusions:</strong> Endonasal DCR with and without stenting, had more or less similar results, with equal post op complications. Though, with stenting, success rates were high as shown in our study.</p> Ajay Karkare Arvind Singh Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 299 303 10.18203/issn.2454-5929.ijohns20241325 Comparison of oral versus intranasal methylcobalamin in patients of tinnitus https://www.ijorl.com/index.php/ijorl/article/view/4227 <p><strong>Background: </strong>Tinnitus is perception of sound in the absence of an external auditory stimulus. It is an experience that originates from a cause or trigger in the cochlea, brainstem or at higher centres.</p> <p><strong>Methods: </strong>A randomized, double-blinded pilot study was conducted, wherein a total of 64 patients were enrolled. Of which 32 were considered as Group A (oral methylcobalamin was administered) and 32 in Group B (intranasal methylcobalamin was administered). Group A patients enrolled randomly received oral methylcobalamin therapy (tablet methylcobalamin 500 mcg tablet once a day for a period of 6 weeks). Group B patients enrolled randomly received intranasal methylcobalamin treatment (nasal spray 500 mcg per day) for a period of 6 weeks.</p> <p><strong>Results: </strong>A sum of 19 patients of the total patients included in the study were found to be Vitamin B12 deficient that is 42.1% were considered to be Vitamin B12 deficient when the normal levels were considered to be 250 pg/ml, which could be considered to be a significantly high prevalence. Patients having Vitamin B12 deficiency showed improvement in visual analogue scale score after vitamin B12 therapy.</p> <p><strong>Conclusions: </strong>Supplementation of Vitamin B12 in vitamin B12 deficient patients having tinnitus has shown symptomatic improvement. However, no significant improvement in visual analogue scale scores in patients without B12 deficiency was observed. There was improvement in VAS in cobalamin-deficient patients receiving Vitamin B12 weekly for 6 weeks.</p> Saurabh Srivastava Anuja Bhargava S. M. Faiz Rajeev Gupta Keshav Gupta Varun Gupta Surabhi Sharma Abdul Khalid Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 304 309 10.18203/issn.2454-5929.ijohns20241326 A study of the prevalence of Onodi cells in a North Indian population https://www.ijorl.com/index.php/ijorl/article/view/4248 <p><strong>Background:</strong> Onodi cells are a type of posterior ethmoid cells which extend superior and lateral to the sphenoid sinus. As these cells have a close relationship with the optic nerve and the internal carotid artery, it becomes important to be aware about their presence preoperatively to prevent injury to these vital structures. Aim of the study was to identify the presence of the Onodi cell with computed tomography (CT) scan and to determine its prevalence and gender distribution of these cells in a north Indian population.</p> <p><strong>Methods:</strong> CT scan of nose and paranasal sinuses of 300 adult patients were studied retrospectively to determine the prevalence of Onodi cells. </p> <p><strong>Results:</strong> The overall prevalence of Onodi cells was found to be 20.33%. Of this, 24 (57%) were present in males and 17 (43%) in females. Out of 61 Onodi cells, 30 (49.2%) were right-sided, 10 (16.4%) left-sided, 13 (21.3%) central and 8 (13.1%) were bilateral.</p> <p><strong>Conclusions:</strong> The presence of Onodi cell in every fifth person makes it important to have a knowledge of their presence preoperatively to prevent adverse surgical complications.</p> Preeti Sharma Sonika Kanotra Seerat Bahir Yasir A. Khan M. Zahid Batt Qazi S. Ahmed Misba M. Bhat Kshitij Gupta Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 310 315 10.18203/issn.2454-5929.ijohns20241327 Facial nerve palsy following bee sting: a case report https://www.ijorl.com/index.php/ijorl/article/view/4257 <p>One of the most common insect poisoning is bee sting. It can produce local symptoms such as pain, redness, and fever following a local pain. Rarely, anaphylaxis, myocardial infarction, organ failure, epilepsy and other neurological diseases have been reported. Lower motor neuron facial nerve palsy is one of the common diseases of the Otorhinolaryngology clinic. Although it is usually idiopathic, trauma and tumors are the two most common causes. Usually, it is diagnosed clinically and the grade of palsy is based on House Brackmann Classification. We present a case of left Bell’s palsy due to bee sting. A 21-year-old male patient was referred to our clinic for persistent incomplete eye closure for two weeks duration. Upon further history, he complained that prior to the left sided facial weakness he was stung by a bee the night before on his left toe and developed the facial weakness when he woke up in the morning. He did not get immediate treatment. Clinically he had Grade III left lower motor neuron facial nerve palsy. Other ear, nose and throat examinations were unremarkable. He was treated with oral steroid and eye care. One week upon follow up, his facial weakness was completely resolved.</p> Khairullah Bin Anuar Maimunah Binti Abdul Munaaim Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 322 323 10.18203/issn.2454-5929.ijohns20241329 The extraordinary case of a welder: retrieval of foreign bodies via transcervical neck exploration https://www.ijorl.com/index.php/ijorl/article/view/4284 <p>Penetrating foreign bodies in the neck can be challenging to locate, especially given the complex anatomy of neck and edematous tissue planes following injury. These foreign entities require prompt surgical exploration for their removal because of risk of migration. Retrieval of foreign bodies relies upon their size and surrounding anatomical tissues. We are reporting an uncommon instance in which an iron chip accidentally penetrated patient's neck, producing acute hoarseness of voice and agony. The foreign body was removed via transcervical neck exploration.</p> Ginni Datta Shefali Sharma Sumit Narang Naiya Rao Ishaan Hriday Darbari Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 324 327 10.18203/issn.2454-5929.ijohns20241330 Canal cholesteatoma: an alarming sequela of congenital aural atresia https://www.ijorl.com/index.php/ijorl/article/view/4247 <p>Congenital aural atresia is an external ear malformation that may have diverse clinical presentations ranging from conductive hearing loss to the formation of canal cholesteatoma. Canal cholesteatoma, once developed can aggressively erode the bony boundaries of the middle ear cleft and lead to dangerous complications. Here we present the clinical outlook and surgical management of a child with congenital aural atresia with extensive canal cholesteatoma and complications. A twelve-year-old girl with congenital aural atresia and microtia of the right ear presented with right sided infra-auricular abscess with overlying skin ulceration. She also had right sided grade 4 facial paralysis. Pure tone audiometry revealed severe conductive hearing loss on the right side. In contrast, a high-resolution computed tomography scan showed extensive soft tissue on the right side completely destroying the posterior bony canal wall, with erosion of the sigmoid plate and the mastoid tip. We performed a right sided modified radical mastoidectomy and canal atresia repair along with the removal of the necrotic and infected tissues. The little girl recovered uneventfully with improved facial nerve function and without any sign of cholesteatoma recidivism. In congenital aural atresia, early surgical intervention is the key to prevent the formation of canal cholesteatoma and subsequent complications.</p> Dhruv Kapoor Annanya Soni Arijit Jotdar Rudra Prakash Vibha Singh Manisha Sagar Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 328 330 10.18203/issn.2454-5929.ijohns20241331 Fungal carotiditis with aneurysm - a rare complication of mucormycosis: presentation and management https://www.ijorl.com/index.php/ijorl/article/view/3773 <p>During the COVID-19 pandemic, cases of mucormycosis (ROCM) had increased drastically, especially in the second wave. Most of these cases involved the paranasal sinuses, orbit and occasionally brain. This case report presents a rare case of mucormycosis complicated with a mycotic aneurysm of the petrous part of the internal carotid artery (ICA). A 43-year-old man presented with left-sided facial weakness for which high resolution computed tomography scan of the Temporal bones was done. A scrutiny of the computed tomography temporal bone showed evidence of osteomyelitis extending to the petrous apex around the foramen Lacerum. Computed tomography and magnetic resonance imaging of the paranasal sinus done later confirmed the diagnosis of mucormycosis. The patient underwent endoscopic surgical debridement of the nose and sinuses, with post-operative amphotericin B. After 3 weeks, the patient presented with bouts of profuse nasal bleed. Computed tomography angiogram showed an aneurysm in the petrous segment of the ICA suggestive of mycotic carotiditis complicated from mucormycosis spread along the skull base. It was successfully managed neurosurgically by a bypass shunting procedure. Mucormycosis is a disease that typically has an aggressive and startling fatality rate. ICA aneurysm is an uncommon occurrence in mucormycosis. Subjects with ROCM should be examined for brain and vascular involvement. Computed tomography angiogram should be performed as soon as possible if the skull base is involved in the ICA area. Morbidity and mortality can often be reduced by early diagnosis and interventions by a multidisciplinary team.</p> Sakshi Gavendra Gopishankar Subramaniasamy Anagha Joshi Renuka Bradoo Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 331 334 10.18203/issn.2454-5929.ijohns20241332 Non recurrent laryngeal nerve: be vigilant https://www.ijorl.com/index.php/ijorl/article/view/4219 <p>The nonrecurrent laryngeal nerve (NRLN) is a rare variant of the RLN, which results from the partial failure of pharyngeal apparatus during embryological development. It’s a rare anatomical variation in which the nerve doesn’t descend to the thorax and enters the larynx directly from the vagus nerve in the neck. It’s an uncommon anatomical variation usually associated with subclavian artery abnormalities, so identification of these vascular anomalies before the surgery is important to avoid nerve injury. These anomalies lead to difficulty in finding the RLN and hence the chances of injury to the nerve are more. Lack of knowledge about the course of RLN, its anatomical variations and its relationship to the vital structures poses the risk of iatrogenic damage of the nerve. Most of the cases of NRLN are diagnosed intraoperatively, as there is no specific test for this. So, surgeons should always be vigilant about the NRLN during thyroid and parathyroid surgeries.</p> Preeti Dhingra Kaustubh Raghuwanshi Sirigiri Naga Mahendra Ritesh Agrawal Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 335 337 10.18203/issn.2454-5929.ijohns20241333 A tale of two stones in nose https://www.ijorl.com/index.php/ijorl/article/view/4229 <p>Rhinolith is stone formation in nose. It is very rare. Here we discuss 2 cases of rhinoliths along with its management and review the literature. First is a case of giant rhinolith detected in a 41-year-old male patient and second is rhinolith in a 52-year-old lady with no known history of foreign body insertion. This article can enable the attending clinician to diagnose this still prevailing condition with high index of suspicion leading to its appropriate management.</p> Sarada Sreenath Saji Sasidharan Elizabeth Thottathikunnath George Saju Kuttiplakal George Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 338 340 10.18203/issn.2454-5929.ijohns20241334 Maxillary sinus unplugged: dealing with foreign bodies in the maxillary sinus https://www.ijorl.com/index.php/ijorl/article/view/4230 <p>Foreign bodies lodged within the maxillary sinus are rare occurrences, presenting diagnostic challenges and requiring tailored surgical interventions. We report a case of male in his mid-sixties, with a history of chronic sinusitis complaining of broke teeth and asking for replacement or the same. Imaging revealed an ectopic tooth lodged within the right maxillary sinus. Infected Schneiderian membrane was intentionally removed and foreign body was removed from the sinus employing innovative techniques to safely remove the foreign body and a long-standing collagen membrane was used to recreate the sinus floor. Postoperatively, the patient experienced complete resolution of symptoms and restoration of sinus function. This case emphasizes the importance of thorough preoperative evaluation and how dental professionals can effectively manage unique cases in their clinical practice with optimal patient outcome in managing maxillary sinus foreign bodies.</p> Lanka Mahesh Saurabh Juneja Athreya Rajagopal Zara Dhawan Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 341 344 10.18203/issn.2454-5929.ijohns20241335 Expanding hematoma with facial nerve palsy: an unusual complication of mandibular fracture https://www.ijorl.com/index.php/ijorl/article/view/4234 <p>The mandible is one of the most commonly fractured facial bones, along with the nasal and zygomatic bones. The most common cause of fracture is trauma, such as a motor vehicle accident, a physical altercation, an industrial accident, a fall, or a contact sport injury. Because of its position and the complex anatomy and environment surrounding it, the mandible is extremely vulnerable and often breaks when a traumatic injury is made to the face. Complications of mandible fractures can range from 7 to 29%, depending on the severity of the injury, the location of the injury, and the number of areas affected. The most frequently encountered complications include infection, hardware failure, osteomyelitis, non-union, mal-union, and wound dehiscence. Here, we report an unusual complication of an expanding hematoma with left sided facial nerve paresis that resulted after 2 months of mandible fracture.</p> Neetu Bajaj Shivam Singh Shweta Bhatnagar Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 345 348 10.18203/issn.2454-5929.ijohns20241336 Multiple squamous cell carcinomas of temporal bone years after radiotherapy for malignancy glottis-report of a rare case with review of literature https://www.ijorl.com/index.php/ijorl/article/view/4237 <p>Larynx is unique in its anatomy. It is critical to map the lesions accurately so that the patient may benefit from the strategy most likely to preserve a functional larynx with the lowest likelihood of recurrence and the least morbidity. We describe a case of 60-year-old male with malignancy glottis diagnosed at the age of 43, treated with external beam radiotherapy, presented 15 years after with swelling in the right upper part of the face, lateral to the eye. Radiological investigations suggested neoplasm in the skin over the right zygomatic part of the temporal bone. Biopsy confirmed malignancy, basal cell carcinoma type. Wide local excision of the lesion with split skin grafting was done. After 2 years, he presented with right ear pain, discharge, and hard of hearing. Examination and radiological investigations confirmed a mass in the external auditory canal, infiltrating through the temporal bone. Biopsy revealed an acantholytic variant of squamous cell carcinoma (SCC). The patient was advised about treatment options and radiotherapy was chosen. Further, a literature search was conducted to detect similar cases. We describe the incidence and prevalence of radiation-induced temporal bone malignancy, an exceedingly rare and late complication of head and neck irradiation. Radiation induced SCCs are highly malignant secondary neoplasms in the head and neck region. It constitutes a therapeutic challenge because of its anatomy and the known side effects of radiation. Timely intervention with a multidisciplinary approach is necessary.</p> Eaiby Sebastian Chelakkattuparambil Sahana Ponnuvelu Devi Dharman Selvarajesh Selvakarikalan Tamilselvi Veeramani Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 349 354 10.18203/issn.2454-5929.ijohns20241337 Nasopharyngeal cyst of branchiogenic origin: a rare case report https://www.ijorl.com/index.php/ijorl/article/view/4253 <p>Nasopharyngeal branchial cysts present laterally as well as ascend from the fossa of Rosenmuller and trace superiorly inside the bony immures of the pharyngotympanic tube. Other commonly related disease conditions with respect to nasopharyngeal cyst include the Rathke’s pouch cyst, Thornwaldt cyst from the pharyngeal bursa along with the branchial cleft cyst. Here in our study, we report a case of a 25-year-old male presented with symptoms of snoring for the past 2 years. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the lateral wall of the nasopharynx extending to the oropharynx. Further based on his radiological investigations, a localized non-enhancing nasopharyngeal cystic mass was seen extending from the left lateral wall of nasopharynx to oropharynx and was diagnosed as nasopharyngeal cyst. Thus, the surgical removal of the nasopharyngeal cyst has been performed through a transoral endoscopic technique with no remnants at the surgical site. The histopathological findings revealed stratified squamous epithelium with subepithelial infiltration of lymphoid follicles, thus confirming the diagnosis as branchial cleft cyst. The patient was discharged with no complications and have been periodically advised for a follow-up. Conclusively, the cyst of 2<sup>nd</sup> branchiogenic origin in the nasopharynx is extremely sporadic and till date, only a small number of cases have been reported.</p> Vignesh Palani Prabu Velayutham Surya Ravichandran Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 355 357 10.18203/issn.2454-5929.ijohns20241338 Multiple cutaneous squamous cell carcinoma of the forehead in a patient with skin of color treated by wide local excision with adjuvant radiotherapy: a case report https://www.ijorl.com/index.php/ijorl/article/view/4255 <p>Cutaneous squamous cell carcinoma is the second most common non-melanoma skin cancer, characterized by the proliferation of keratinocytes, with an increasing incidence worldwide. In cases of perineural invasion, surgical excision followed by adjuvant radiotherapy is the preferred treatment. An intraoperative frozen section is necessary to determine the cancer-cell-free margin. A 80-year-old male presented to the outpatient department of our hospital with two fungating growths over his right forehead (size 2.7×1.2 cm) and right temple region (size 4×1.2 cm) for 5 years. An incisional biopsy of the growths revealed well-differentiated squamous cell carcinoma. There was no evidence of lymphadenopathy. The patient was treated successfully by wide local excision of the growths with an intraoperative frozen section to determine negative margins. Local defects of the forehead and right temple were reconstructed with a scalp rotation flap and a split skin thickness graft, respectively. The final histopathological examination showed moderately differentiated squamous cell carcinoma with resection-free margins. Forehead growth showed perineural invasion. The patient underwent 30 fractions of image-guided adjuvant radiotherapy in view of perineural invasion and to avoid local recurrence. The patient recovered well without any recurrences or complications. Surgical excision and reconstruction followed by adjuvant radiotherapy is the most effective method for treating cutaneous squamous cell carcinomas with perineural or lymphovascular invasion. Intraoperative frozen section is necessary to reduce recurrence rates and metastasis. Ours is a rare case of multiple cutaneous squamous cell carcinomas involving the forehead region.</p> Vishnupriya Pari Biswanath Roy Surajit Gorai Saptarshi Bhattacharya Tanweer Shahid Ritu Srivastava Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 358 361 10.18203/issn.2454-5929.ijohns20241339 A case series on the determination of pre-operative risk factors for anticipation of post operative hypocalcaemia in thyroidectomy https://www.ijorl.com/index.php/ijorl/article/view/4232 <p>During thyroidectomy, careful dissection of the parathyroid and tracing of their blood supply is the dictum. But it may not always be possible. We aim to highlight some of the common situations faced by ENT surgeons during thyroidectomy, where intraoperative identification and preservation of either the parathyroid glands or their blood supply may be difficult or the glands may have to be sacrificed. We wish to highlight 5 cases where hypocalcemic tetany occurred after total thyroidectomy and pre operative anticipation of their risk factors and the reasoning for the same. Extra precaution should be taken to try and identify and preserve at least one parathyroid gland to prevent lifelong morbidity due to hypocalcemia. Additionally, one must be on the lookout for such challenging cases preoperatively and appropriate consent should be taken from the patient.</p> Akash Adhikary Kumar Shankar De Bivas Adhikary Copyright (c) 2024 International Journal of Otorhinolaryngology and Head and Neck Surgery 2024-05-24 2024-05-24 10 3 316 321 10.18203/issn.2454-5929.ijohns20241328