International Journal of Otorhinolaryngology and Head and Neck Surgery

Metastasis to an odontogenic cyst: case report and review of literature

Shayan Sadeghi — 2024-11-26

Metastatic disease to the jawbone is relatively uncommon. However, its occurrence within a pre-existing odontogenic cyst or tumor is extremely rare. We present a case of a 61-year-old woman experiencing fatigue and nocturnal diaphoresis with an otherwise asymptomatic radiolucent lesion of the mandible. Radiographic features were suggestive of a benign odontogenic cyst. A biopsy revealed a metastatic nidus within the wall of a benign odontogenic cyst. Further investigations confirmed the presence of a primary pulmonary adenocarcinoma. Diagnosis of metastases to the orofacial region may be challenging because of their various clinical and radiographic features. Thorough histopathological analysis of any routine cystic tissue from the maxillofacial structures, even seemingly benign, is necessary to rule out more aggressive disease.

Distinctive presentation of pinna squamous cell carcinoma as devil cutaneous horn

Tanvir Hussain — 2024-10-02

Cutaneous horns are considered rare clinical elements defined by compact exophytic keratin growth typically resembling an animal’s horn. They are prone in the body’s sun-exposed areas, arising from various benign, malignant and premalignant conditions. Therefore, this paper reflects a reported case for the 75-year-old male diagnosed with cutaneous horn in his right pinna. The histopathological evaluation confirmed a squamous cell carcinoma (SCC). The case has equally stressed why histopathological assessment or examination is necessary to determine the condition’s nature and proper management. The patient was taken through a wide local excision with a comprehensive assessment and evaluation and the multidisciplinary discussion with an oncology and head expertise team. From the case, it is necessary to practice vigilance and caution in diagnosing and managing the condition from unusual places like the ear.

Large thyroglossal duct cyst with a long term evolution: a case report

Isabel Serrano-Trejo — 2024-11-26

A 57-year-old male presented with a progressively enlarging mass in the anterior cervical region, persisting for 41 years without accompanying symptoms. Physical examination revealed a well-defined, mobile, soft mass measuring 16×15×15 cm, not fixed to deep tissues, and extending from the medial edge of the sternocleidomastoid muscle. Computed tomography scan showed a cystic lesion involving the hyoid bone, suggestive of a thyroglossal duct cyst. The patient underwent a Sistrunk procedure, with dissection from the base of the tongue to the sternal notch. He was discharged six hours after surgery without any complications and had a closed drainage system removed during a subsequent outpatient visit.

Foreign body lodged in the subglottic area: a case report in a child

Ibrahima Diallo — 2024-11-26

Subglottic foreign bodies are rare and represent an extreme emergency that can threaten life. Our aim is to share our experience in the management and multidisciplinary approach to a subglottic foreign body in a child. We report the case of a 4-year-old child from a rural area, who was admitted as an emergency. He was referred by the pediatric team after presenting with symptoms of foreign body aspiration. The general examination revealed laryngeal dyspnea (stage IV) with unstable hemodynamic parameters. ENT examination showed pharyngeal granulations; near-obstructive hypertrophy of the inferior turbinates, muco-purulent rhinorrhea with pale nasal mucosa; cerumen plugs, and intact tympanic membranes. Pulmonary auscultation noted crackles in both lung fields. We diagnosed a laryngo-tracheal foreign body complicated by stage IV laryngeal dyspnea. The child underwent an emergency tracheostomy followed by endoscopy and removal of the foreign body. The postoperative course was uncomplicated. Although rare, subglottic foreign bodies present a challenge for early management. Therefore, we emphasize to our colleagues the severity of subglottic foreign bodies. Prevention is the best therapeutic alternative.

Navigating nasal swelling: the diagnostic journey to osteoblastic osteosarcoma

Tiong Siew Lee — 2024-11-26

Nasal swelling is frequently encountered in ENT, but diagnosing osteosarcoma in the head and neck region is quite uncommon. Diagnosing and managing craniofacial osteosarcoma is challenging due to its rarity and nonspecific radiological features, which often lead to biopsy errors. Additionally, the proximity to vital structures complicates achieving complete resections. MRI is the gold standard for detailed assessment of osteosarcoma, offering crucial insights into tumor extent, soft tissue involvement, and proximity to surrounding structures for effective treatment planning and response monitoring. CT supports this by aiding in biopsy planning, staging, and detecting metastases, particularly in the chest. Craniofacial osteosarcoma treatment lacks consensus but generally prioritizes surgery, with negative margins crucial for better outcomes. Adjuvant chemotherapy can boost survival, while radiotherapy is used when complete surgery is not possible. In this case, we bring your attention to a 31-year-old gentleman who presented with progressive and painless nasal swelling for 6 months prior to visiting the ORL clinic, where a final diagnosis of osteoblastic osteosarcoma was made after history, examination, imaging, and histopathology results.

Primary nasal tuberculosis due to inoculation by nasal picking: a case report

Ravi Sachidananda — 2024-11-26

Tuberculosis of the nose is a rare entity and is usually secondary to pulmonary tuberculosis. Due to its nonspecific presentation, it can be easily missed. Early diagnosis and treatment helps to prevent associated morbidity. We present a case of nasal tuberculosis in a 39-year-old male patient with the habit of nasal picking who presented with a non-healing septal ulcer. Histopathology revealed the diagnosis of tuberculosis. He did not have any evidence of pulmonary tuberculosis. A diagnosis of primary nasal tuberculosis due to inoculation by finger nail trauma was made and patient was treated with antitubercular medications. It is important to have a high index of suspicion to prevent late diagnosis and sequelae.

Cerebrospinal fluid otorrhea masquerading as cerebrospinal fluid rhinorrhea: a rare presentation

Amitha A. Asharaf — 2024-11-26

Congenital inner ear disorders are associated with cerebrospinal fluid (CSF) leaks and recurrent meningitis. Here we present a case report of a 47-year-old male patient who presented with CSF rhinorrhea and recurrent meningitis with an unidentified congenital inner disorder, which was later identified as CSF otorrhea, and had leak repair done. In this paper, we stress considering CSF otorrhea as a differential diagnosis while dealing with the presentation of recurrent meningitis.

An incongruous occurrence: rare case of a huge sinonasal neurofibroma

Vikas Malhotra — 2024-11-26

Neurofibromas (NF) are benign peripheral nerve sheath tumors that arise from schwann cells and intraneural fibroblasts. Solitary NF are extremely rare with only a few reported cases in the literature that involve the nasal cavity and paranasal sinuses. Due to its slow growth and the non-specific nature of the symptoms, its clinical presentation and diagnosis is often delayed. Here we present a case of a 65 year old female with left sinonasal neurofibroma which was surgically managed in our department successfully. It was 9.5 cm in greatest dimension and weighed 380 gm which is the largest amongst the available published reports that we could find.

An unusual occurrence: Treacher Collin syndrome with nasal dermoid cyst

Shivangi Manglik — 2024-11-26

Treacher-Collins syndrome (TCS), characterized by autosomal dominant inheritance, affects craniofacial development and presents with diverse clinical manifestations, including facial bone hypoplasia, ear malformations, and ocular abnormalities. The syndrome's association with nasal dermoid cysts is rare and poorly documented in the literature. We present a case report of a 10-year-old male with TCS who presented with a nasal dermoid cyst, a noteworthy and atypical finding within this patient population. The patient exhibited typical features of TCS, including facial asymmetry, malar and mandibular hypoplasia, and microtia. The diagnosis was confirmed through clinical evaluation and diagnostic imaging, which revealed additional anomalies such as conductive hearing loss and absence of the external auditory canal. Surgical excision of the nasal dermoid cyst was performed, utilizing the V-Y advancement glabellar flap technique for closure. This case underscores the importance of comprehensive multidisciplinary care in managing complex conditions like TCS, where treatment strategies must address both medical needs and cosmetic outcomes. Further exploration of rare associations like nasal dermoid cysts in TCS contributes to a broader understanding of the syndrome's phenotypic variability and informs optimal clinical management strategies.

A case report of nasal lobular capillary hemangioma and its management

Vybhavi M. K. — 2024-11-26

Nasal lobular capillary hemangioma is a benign vascular lesion marked by epistaxis and nasal obstruction. The nasal cavity is a relatively rare location as lobular capillary hemangiomas commonly occur in the oral cavity. They are termed as lobular capillary hemangioma based on the histopathological features of anastomosing capillary networks arranged in lobular architechture. We report a case of 40 year old female with history of left nasal obstruction and recurrent epistaxis since 2 months. Examination of nose revealed a protruding reddish coloured mass on the left side and CT scan of nose and paranasal sinuses showed the mass arising from the anterior part of nasal septum along with nasal spur. Patient underwent surgical excision of the mass along with spur removal under general anesthesia. Histopathology demonstrated vascular proliferative lesion consistent with hemangioma. The diagnosis of capillary hemangioma must always be taken into account while considering the differential diagnosis of bleeding mass in the nasal cavity.

The application of oral-motor learning principle in a patient with severe communication disabilities: a case study experience

Saheli Biswas — 2024-11-26

This study explores the use of oral-motor learning principles in the rehabilitation of a 7 years 7 months-old male patient with severe intellectual disability secondary to spastic cerebral palsy, seizure disorder and visual impairment. The objective was to assess the effectiveness of these principles in improving communication abilities in patients with severe communication disabilities. The patient underwent 20 therapy sessions, each lasting 45 minutes, with the goal of achieving functional communication skills up to the single-word level (5-10 words) in clinical settings. Non-speech oral motor exercises were implemented using oral-motor sensory integration toolkits to improve vegetative functions and reduce sialorrhea and enhanced speech and language skills. Both tactile and speech kits were used concurrently. The study concludes that oral-motor sensory integration toolkits may serve as standardized tools for effectively addressing oral motor deficits in patients with similar conditions.

Extraluminal migration of foreign body and its removal by lateral pharyngotomy and intraoperative C-arm

Arun M. Sattien — 2024-11-26

Ingested foreign bodies are not unusual in Manipur. The most common of these are fish bones, which usually gets impacted in the tonsils, base of tongue or at the level of cricopharynx. Sometimes few may migrate extraluminally, or even extrude subcutaneously. We report a case of an ingested foreign body (beef bone) which had migrated to retropharyngeal space requiring lateral pharyngotomy using C-arm guidance for removal.

Unnoticed breakage of airway exchange catheter during nasal endotracheal tube exchange

Shilpa Tiwaskar — 2024-11-26

During unanticipated difficult intubation, amidst the various attempts and techniques, the anaesthesiologist tries using various airway adjuvants to facilitate endotracheal intubation. After successful intubation, seldom do we check the integrity of adjuvants used. Our case report emphasizes on the need of checking integrity of airway adjuvants after their use in emergency situations. In addition, the report also highlights the fact that, adjuvants on the difficult airway cart must be checked daily for quality, friability, stickiness, any cracks, bends, damages, pliability, their mere presence on difficult airway cart is of little significance.

Orbital apex syndrome secondary to sinusitis

Adi S. S. Pavani — 2024-11-26

The orbital apex disorders include superior orbital fissure syndrome, cavernous sinus syndrome, and orbital apex syndrome. A 50-year female patient presented to hospital with complaints of right eye heaviness since 3 days, decrease vision since 5 days. Right sided headache, right eye blurred vision, ptosis of right eye lid for 1 week. On ophthalmologic examination ptosis and blurred vision in right eye seen. Visual acuity in right eye shows counting fingers close to fingers (CFCF), exotropia, extraocular movements reduced. Computed tomography paranasal sinus (CT PNS) plain and contract showed bilateral sphenoid, right maxillary and right posterior ethmoid sinusitis. Magnetic resonance imaging (MRI) brain showed ill-defined type 2 hyper intensity at right orbital apex and right cavernous sinus showing moderate enhancement with adjacent dural thickening and abnormal enhancement of anterior clivus suggestive of Infective etiology. Right anterior and posterior ethmoidectomy, right fronto-spehenoidectomy, right orbital decompression done.

Post traumatic schwannoma over right temporo-zygomatic region: a case report

Yash A. Gandhi — 2024-11-26

Schwannomas are benign tumour. Post traumatic schwannoma over head and neck region is a rare entity. The occurrence of head and neck schwannomas is approximately 25-50%. The most common site of occurrence of schwannoma in head and neck region is found to be lateral part of neck. Schwannoma is a radio-resistant tumour. Complete surgical excision is the definitive management. The characteristic histopathological finding in Schwannoma is Antoni A area and Antoni B area of cellularity and Verocay bodies. We report a rare case of post traumatic schwannoma over right temporo-zygomatic region in an 18-year-old female.

Rare case of low-grade fibro-myxoid sarcoma presenting as a lateral neck swelling

Sharvil M. Nimavat — 2024-11-26

Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon malignancy. LGFMS is more likely to affect the trunk and extremities in young adults. However, sporadic cases have been reported in many areas of the head and neck region, including the oral cavity, larynx, and oropharynx. LGFMS typically shows areas of collagenized, myxoid stroma with spindle cell appearance in a rolling pattern. Accurate diagnosis is challenging because it can be mistaken for a simple neoplastic entity of round cells. A few cases of LGFMS which have been reported in the head and neck showing that LGFMS is characterized by local recurrence and metastases. Because of the rarity of the head and neck region, there are no specific treatment guidelines or follow-up. Our study presents LGFMS in a 54-year-old patient in the neck region who underwent surgery and was followed up for one year.

Basal cell adenoma-parotid: a rare entity

Neha Anand Shendge — 2024-11-26

Basal cell adenoma is a rare benign tumour found in the parotid gland, typically in patients aged between their fifth and seventh decades. In two cases we observed, patients presented with a gradually increasing, painless, and movable swelling in the parotid region. The condition was successfully managed through a Superficial Parotidectomy operation, and the final histopathological report confirmed the presence of basal cell adenoma. This tumour is one of the 11 benign salivary gland tumours classified by the WHO and represents only 3% of head and neck neoplasms. It is primarily located in the superficial parotid gland, and due to its rarity, there is limited literature available on this entity. Diagnosing such tumours is crucial, as non-invasive diagnostic procedures are not always reliable in distinguishing between benign and malignant conditions. A differential diagnosis with basal cell adenoid cystic carcinoma and basaloid squamous cell carcinoma is necessary due to their differing prognostic implications. Early and accurate identification is essential to guide appropriate treatment and improve patient outcomes.

Drug induced reversible cardiomyopathy reported for liposomal amphotericine B: a rare documented adverse event

Nisha Kumari — 2024-11-26

Liposomal amphotericin B (LAmB), lipid formulation of amphotericin B (AmB) is used in the treatment of fungal infections, including invasive disease and cryptococcal meningitis and is associated with fewer nephrotoxic and infusion-related adverse effects than conventional amphotericin B. Cardiac toxicity due to LAmB is a rarely reported adverse event in literature. Here we report a case of 53 years female known case of vitiligo, Diabetes mellitus Type 2 diagnosed as case of sinonasal mucormycosis and started on inj LAmB, developed chest pain on day 4 of inj LAmB. ECG and 2D ECHO showed VPBs and ventricular ectopics that were transient and completely recovered on reducing the dose of LAmB. As LV function has recovered on reducing Liposomal AMB, and patient was not on any other cardiotoxic drugs. It was concluded that the patient developed Transient Cardiomyopathy also known as Takotsubo Cardiomyopathy likely due to Liposomal AMB that improved on reducing dose of the drug LAmB. Although very rare but reversible cardiomyopathy also known as Takotsubo Cardiomyopathy due to LAmB is a documented adverse effect. Therefore, ECG monitoring or cardiac monitoring (2D ECHO) should be done when patient is started on LAmB and if at any point cardiotoxicity is suspected then drug should be stopped or reduced in dose immediately. These adverse effects are reversible which recovere on stopping or reducing the dose of LAmB.

Exposition of an unusual presentation: a case report of benign tumor arising from an uncommon origin

Prabu Velayutham — 2024-11-26

The inverted papilloma is a benign neoplasm that originates from the sinonasal mucosa, which is also referred to as a Ringertz tumor. It mostly affects men, falling within the age groups of 50 to 60 years. Our case is rare of its type as it was present in an unusual site, which is from the middle turbinate. Here in our study, we report a case of a 25-year-old female presented to the ENT outpatient department with complaints of left-sided nasal obstruction for 4 years. The patient had noticed a pinkish mass in the left nasal cavity. She complained of intermittent episodes of left-sided nasal bleeds. The patient was planned for functional endoscopic sinus surgery with a partial middle turbinectomy under general anaesthesia. Histopathological examination showed polypoidal tissue fragments lined predominantly by non-keratinized stratified squamous epithelium, along with focal areas lined by respiratory-type pseudostratified columnar epithelium and transitional epithelium, with multiple foci of inward proliferation of the epithelium in the form of nests into the underlying sub epithelium with an intact basement membrane, which is suggestive of inverted papilloma. After one week of postoperative follow-up, patient’s symptoms of nasal obstruction were relieved. During the subsequent 6 months of follow-up, the patient had no evidence of tumor recurrence. In our case, we wanted to emphasize that not all cases that do not involve the maxillary sinus or the medial wall of the maxilla on a CT scan require medial maxillectomy.

Vestibular migraine management by the United Kingdom ear, nose and throat clinicians: a “snapshot”

Amberley Munnings — 2024-11-26

Background: Vestibular migraine is a common cause of dizziness with various management options, similar to that of regular migraine treatments. This study aimed to characterise current practice in vestibular migraine (VM) management amongst ear, nose and throat (ENT) specialists across the United Kingdom (UK).

Methods: A national survey of ENT UK members regarding their management of VM was conducted. Freedom of information requests were also sent to each integrated health board (IHB) to determine if they had a migraine and/or vestibular migraine protocols.

Results: There was wide variability across ENT clinicians in their management of VM with 45.29% starting no treatment or lifestyle advice only before transferring the care of the patient to another provider. Only 4 IHBs had a migraine protocol that referenced VM.

Conclusions: This study identifies the variation in the management of vestibular migraine across ENT clinicians. It also potentially highlights the need for improved education of ENT trainees about the condition. The authors would support ENT clinicians to become involved in writing migraine protocols for their trusts, to include vestibular migraine within these guidelines.

Early hypocalcemia following thyroidectomy in Kurmitola General Hospital, Dhaka, Bangladesh

Rahmot Ali — 2024-11-26

Background: Hypocalcaemia is a recognized complication after thyroidectomy, which may be transient or permanent due to impairment of blood supply, injury, or inadvertent removal of the parathyroid gland. Parathormone, secreted by parathyroid gland, plays an important role in calcium homeostasis. Purpose of this study was to enable early detection of hypocalcaemia after thyroidectomy, aiding in patient management, early discharge, and reduced hospital stay.

Methods: This study was conducted in the otolaryngology and head-neck surgery department of Kurmitola General Hospital over 12 months, from January 2020 to December 2020. Patients with various indications were selected based on eligibility criteria through convenience sampling. Data were collected using a data collection sheet, then cleaned, edited, and tabulated. The results were analyzed using the student’s unpaired t-test (quantitative data) to determine their significance, with a p cut-off set at <0.05.

Results: Data analysis of 30 patients (30% male, 70% female) revealed that 13 patients experienced hypocalcaemia, while 17 showed normocalcaemia. Among the 13 hypocalcaemic patients, 10 (76.92%) had asymptomatic (subclinical) hypocalcaemia, and 3 (23.08%) had symptomatic hypocalcaemia. Hypocalcaemia was observed in 46.15% of patients within 24 hours post-surgery, 38.46% within 48 hours, and 15.39% within 72 hours. The results indicated a female predominance in the development of hypocalcaemia.

Conclusions: The study suggests that serum calcium levels significantly decrease after total thyroidectomy, with most cases occurring within 48-72 hours post-surgery.

Correlative evaluation of findings between ultrasonography, fine needle aspiration cytology and histopathology in cases of goitre

Huma Akbar Gauri — 2024-10-02

Background: Thyroid imaging reporting and data system (TIRADS) criteria is followed in ultrasonography (USG), based on the risk of malignancy depending on the presence of suspicious ultrasound features. Patients in the high-risk category of TIRADS undergo fine needle aspiration cytology (FNAC), with the Bethesda classification used to determine the risk of malignancy. There is dearth of data comparing sonographic classification of thyroid nodule and its cytological association with respect to final histopathological diagnosis in India.

Methods: Prospective observational study on correlation of USG, FNAC and HPE of thyroid swellings conducted in department of otolaryngology at Jaipur national university institute for medical science and research centre, Jaipur, Rajasthan from June 2022 to April 2024 on 50 patients with palpable thyroid lump.

Results: In the present study, USG has a sensitivity of 63.63%, specificity of 97.44%, a positive predictive value (PPV) of 87.5%, a negative predictive value (NPV) of 90.4% and an overall accuracy of 84.00%. FNAC shows a sensitivity of 72.7%, specificity of 89.7%, PPV of 66.7%, NPV of 92%, and an overall accuracy of 86%.

Conclusions: Benign lesions on both FNAC and USG were almost in concurrence with HPE in our study. The results of FNAC for diagnosing malignancy in our study were almost at par with the results of HPE and outweighed the results of USG. Surgical management should be based on FNAC finding even if USG shows benign features. It should be essential part of armamentarium of evaluation of thyroid swelling. This combined approach provides a robust framework and enhances the accuracy for distinguishing between benign and malignant thyroid lesions, ultimately contributing to improved patient care and outcomes. However, the histopathological examination will remain the gold standard.

Comparative analysis of nasal endoscopic and radiological findings in chronic rhinosinusitis patients

Virali Prabhulal Kagathara — 2024-10-02

Background: Chronic rhinosinusitis (CRS) is a complex inflammatory disorder causing significant reduction in quality of life and interfere in day to day activity. Accurate diagnosis is crucial for effective management, typically involving nasal endoscopy and CT imaging to assess the extent of sinus involvement.

Methods: This prospective observational study was conducted at Jaipur national university institute of medical sciences and research centre from July 2022 to May 2024. It included 75 patients diagnosed with CRS. Subjective quantification of disease was done using SNOT-22 scoring system. Diagnostic evaluations were performed using nasal endoscopy and CT scans, with findings scored according to the Lund-Kennedy and Lund-MacKay systems.

Results: The study highlighted a strong correlation between endoscopic and CT findings, with Pearson correlation coefficients of 0.892 and 0.909 for endoscopic vs. SNOT-22 scores and CT vs. SNOT-22 scores, respectively. Discrepancies between the two diagnostic tools were also noted, emphasizing their complementary roles in CRS management.

Conclusions: Integrating nasal endoscopy and CT imaging provides a robust framework for diagnosing and managing CRS, allowing for a detailed assessment of both mucosal and anatomical changes. The combined use of these tools enhances the ability to tailor treatment plans effectively.

The clinicopathological evaluation of diseases of external ear in tertiary diseases

Soumya Saini — 2024-11-26

Background: As the major part of outpatient department (OPD) comprises of diseases related to external ear, it is a need to acknowledge the topic. These diseases are sometimes seasonal and variable according to climate. Diseases may vary according to patients’ anatomy. Histopathological examination along with clinical prospective is required to remove the diseases. Advancement in radiology has made easier to determine the extension and involvement of disease. Aim of the study is to evaluate the extent of disease, its causative factors, various associations and effect of treatment.

Methods: The observational cross sectional study is done on 211 patients. Detailed study is done and microscopic evaluation is done whenever required. Biopsies and pus samples taken for the histopathological and microbial examination. The data collected and entered in Microsoft excel and analysed data is presented in from of frequency and percentage shown by pie charts and tables.

Results: Out of total 211 patients the commonest involved age group (56.4%) belongs to 21-40 years with 109 (51.7%) females and 102 (48.3%) males. 91% of the patients belong to lower rural socioeconomic status. Most common pathology found in my study was otomycosis in 95 (30%) cases. Other pathologies included otitis externa in 57 (27%) cases, auralmass in 33 (15.6%) cases perichondritis, keloid, preauricular sinus, pseudocystand EAC stenosis in descending order.

Conclusions: Aural polyps and aral masses are found to be more intrusive. Prompt consideration of such cases should be done as they have tendency of extending intracranially.

Post traumatic cerebrospinal fluid rhinorrhea: a descriptive study

Malavika Madathumpadikal — 2024-11-26

Background: Post-traumatic CSF rhinorrhea occurs following head trauma or after intracranial surgery. Traumatic CSF rhinorrhea can be detrimental with complications such as bacterial meningitis.

Methods: Retrospective review of hospital records of post-traumatic patients admitted under neurosurgery department from 2016-2021 was done. 66 patients with CSF rhinorrhea were identified. Their mode of trauma, management and radiological images were reviewed and recorded.

Results: Out of the 66 patients, 87.8% were males and average age group 20-30years. 41 resolved with conservative management. Frontal bone was most common site of rhinorrhea. In 61.8% (n=41) patients, fracture was seen in more than one bone/anatomical site. Incidence of post-traumatic CSF rhinorrhea in this study in 6.6%.

Conclusions: Early diagnosis and management are important to prevent complications. In majority of cases, the leak subsides with conservative management, hence early surgical intervention is not required.

Comparing the efficacy of repositioning manoeuvres over medications in the treatment of posterior and lateral canal benign paroxysmal positional vertigo: a prospective, randomized and comparative study

Anbukarasi Ramalingam — 2024-11-26

Background: Benign paroxysmal positional vertigo (BPPV) is a benign peripheral disorder of vestibular system and is the most common cause of peripheral vertigo. The aim of our study was to compare and assess the efficacy of Epley’s and Barbeque roll over manoeuvres with labyrinthine sedatives in the management of Benign Paroxysmal Positional Vertigo (BPPV) over a period of one month and to know the prevalence of BPPV in different age and gender groups among the two semicircular canals(posterior and lateral).

Methods-This prospective randomized comparative clinical trial included 60 patients with clinically diagnosed BPPV in a tertiary care centre and were investigated for a period on one year. The clinical diagnosis of specific canal type of BPPV was assessed based on the diagnostic tests, Dix Hallpike test and McClure test. In manoeuvre group, posterior canal BPPV, Epley’s manoeuvre was performed and for lateral canal BPPV, Barbeque roll over manoeuvre was performed as treatment. In pharmacological group, labyrinthine sedatives i.e. either cinnarizine 25mg twice a day or betahistine 16 mg twice a day were administered for one month as treatment.

Results: Results were assessed at the end of 48 hours (immediate time period) and at four weeks’ time period after the treatment, under three different outcome categories namely disappeared, improving and unchanged. Treatment of Benign Paroxysmal Positional Vertigo with repositioning manoeuvre had higher success percentage of 83.3% than the medical treatment.

Conclusion: The treatment of BPPV with repostioning manoeuvres had a better outcome than the medical treatment.

Assessment and to evaluate the eminence of depth of invasion in gingivobuccal sulcus carcinoma with the use of preoperative computed tomography and to compare it with depth of invasion measured histopathologically in the resected primary tumor, with the cervical nodal metastasis

Venkatesh Anehosur — 2024-11-26

Background: Depth of invasion (DOI) being one of the significant predictors in determining the prognosis of the disease, hence this data is available only post operatively but now with the advance technology we can assess DOI preoperatively. Here in our study, we used contrast enhanced computed tomography scan (CECT) to determine preoperative DOI. This measured data eventually helps the surgeon to plan resection of the oral primary tumor 3 dimensionally with safe margins.

Methods: Prospective study was conducted between 2019 to 2021 with patients diagnosed with Gingivobuccal sulcus (GBS) carcinoma who were subjected for resection with neck dissection procedures. Preoperative CECT scan was performed to evaluate the depth of invasion (DOI). This was then compared with the DOI measured post operatively of resected specimen by histological assessment. A cut-off value for DOI was derived, beyond which nodal metastasis was evident.

Results: Out of 51 patients 40 (78.4%) were male patients and 11 (21.6%) were female. Age ranged from 20 to 70 years. Preoperative DOI measured from CECT scan showed average value of 18.84 mm, with sensitivity of 100% which was highly statistically significant. Histopathological DOI showed average value of 7.26 mm. lowest DOI at which nodal metastasis observed was 3.4mm, so the cut-off value of DOI above which metastasis was probable decided was 3.5mm for this series.

Conclusions: Hence CECT scan showed better sensitivity and specificity in determining early bony invasion in GBS carcinomas. Thus, making DOI a very reliable and predictable prognostic factor in oral GBS carcinoma.

Knowledge, attitudes, and practices of gynaecologists and paediatricians regarding newborn hearing screening in Odisha

Dipika Behera — 2024-11-26

Background: Gynaecologists and paediatricians are crucial in detecting hearing loss at the first level of intervention. These healthcare workers are the ones who initially interact with infants and their parents. Therefore, they must understand the risk factors for newborn hearing loss and have a positive attitude toward early intervention. There were few studies conducted to evaluate the Knowledge Attitude and Practices (KAP) of New Born Hearing Screening (NBHS) among paediatricians and other physicians in Western countries and few in the Indian context. Thus, the current study aims to compare and examine the knowledge, attitudes, and practices of gynaecologists and paediatricians regarding newborn hearing screening in Odisha.

Methods: A survey questionnaire containing 45 close-ended and 5 open-ended questions was developed. This questionnaire was validated by paediatricians, gynaecologists, and audiologists and then applied among 300 professionals in Odisha.

Results: In all the sections it was found that paediatricians have greater knowledge than gynaecologists, however, both professionals have a positive attitude towards NBHS in Odisha. Mann-Whitney U test revealed significant differences in knowledge, attitudes, and practices among paediatricians and gynaecologists in Odisha.

Conclusions: From this survey, it can be concluded that most of the paediatricians know more about paediatric hearing loss in comparison to gynaecologists, while both of them have positive attitude in implementing NBHS in Odisha. An awareness should be created among both the professionals about NBHS, effect of hearing loss and to whom they can refer for NBHS, which will benefit the newborns and their parents.

A cross sectional study of prevalence and association of sensorineural hearing loss in patients with type 2 diabetes mellitus

Vybhavi M. K. — 2024-11-26

Background: Diabetes mellitus (DM) is a chronic metabolic disorder associated with various long-term complications and among them hearing loss is one of the underestimated comorbidity. Objectives were to evaluate the prevalence of sensorineural hearing loss (SNHL) and to determine the association of age, gender, duration and control of DM with hearing loss.

Methods: A total of 130 patients aged 30-65 years with type 2 DM were included in this cross-sectional study. All patients were subjected to detailed history taking, ear, nose and throat examination followed by pure tone audiometry and measurement of glycosylated haemoglobin (HbA1c) levels.

Results: In this study, SNHL was seen in 70.76% of patients. Statistically significant association was found between the older age group, longer duration of DM and SNHL (p=0.00 and 0.002). Significant association was also seen between the severity of hearing loss and HbA1c levels with p=0.01.

Conclusions: Our study showed a high prevalence (70.76%) of SNHL among type 2 diabetic patients and evidently demonstrated significant association between age of the patients, duration of diabetes and SNHL as well as the association between glycemic control and the severity of hearing loss.

Role of leukotriene receptor antagonist in improvement of symptoms after functional endoscopic sinus surgery for chronic rhinosinusitis with or without sinonasal polyposis

Joemol John — 2024-11-26

Background: Chronic rhinosinusitis is one of the common ENT diseases encountered daily. Due to its chronicity, it leads to patient morbidity and decreased quality-of-life of the patient. Although various medical and surgical management options are available, none can manage the condition effectively. So, the aim of the study is to evaluate the efficacy of the montelukast in the subjective and objective improvement after the FESS for patients with chronic rhino sinusitis.

Methods: This randomized controlled trial was conducted among 50 patients diagnosed with chronic rhino sinusitis. All the patients underwent FESS, and after that, they were divided into two groups; one group received the Montelukast tablet in addition to the standard post-operative regimen, and the other group received the standard post-operative medications only. The subjective and objective measurements were made using SNOT-22 and Lund-Kennedy endoscopic scores during the pre- and post-operative periods.

Results: The study showed a significant reduction in the various parameters of SNOT-22, viz runny nose (p=0.013), cough (p=0.003), post-nasal discharge (p=0.037), thick nasal discharge (p=0.013), ear fullness (p=0.021), difficulty in falling asleep (p=0.018), walking up at night (p<0.001), reduced concentration (p=0.001) in Group-A than in Group-B. The study also showed a significant reduction in the overall SNOT-22 score in the Group-A. The Lund-Kennedy endoscopic score (p=0.006) also showed a significant reduction during the postoperative period in Group-A.

Conclusion: The Montelukast positively affects the reduction of the various domains in the SNOT-22 and the Lund-Kennedy endoscopic score. It can be used as adjuvant therapy during the post-operative period in patients operated with FESS for CRS.

Management of cutaneous head and neck squamous cell carcinoma with trigeminal nerve involvement: a systematic review

Justin Maldonado — 2024-11-26

Cutaneous head and neck squamous cell carcinoma (cHNSCC) is the second most common cancer worldwide, carrying a favorable prognosis. Perineural invasion/spread dramatically reduces survival outcomes. The trigeminal nerve (CNV) is most commonly affected, providing abundant opportunities for skull base and intracranial cavity invasion. Standard treatment includes surgery and radiotherapy (SRT). We intended to systematically review the literature on cHNSCC with CNV involvement and evaluate the effects of treatment modalities and pattern of CNV invasion/spread on outcomes. We performed a systematic review according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Kaplan-Meier curves were utilized to determine the impact of treatment and pattern of invasion/spread on disease-free survival (DFS) and overall survival (OS). Fifty-one studies were identified, generating a sample size of 172 patients with cHNSCC and CNV involvement. The most common treatment modality was SRT (n=90, 52.9%), and all three major CNV branches were affected with similar frequency (V1 33.7%, V2 33.7%, V3 32.6%). Cox proportional hazards regression models revealed significant differences in OS for V1 vs V2 involvement (HR 2.84 95% CI 1.02-7.89), skull base invasion (HR 3.90 95%CI 1.30-11.65), SRT vs RT alone (HR 5.77 95% CI 2.13-15.6), SRT vs other treatment (HR 6.21 95 CI 2.24-17.20). Only SRT and RT had a significant difference in DFS (HR of 3.90, 95%CI 1.30-11.65). In cHNSCC with CNV involvement, treatment modality and the pattern of CNV are crucial for locoregional control and mortality. V1 involvement and definitive RT are associated with significantly lower survival curves.

Cultural adaptation and validation of “aging voice index” in Bengali

Rumela Adhikary — 2024-11-26

Changes in voice due to aging impact the ability to use one’s voice to communicate in all situations and can decrease their quality of life. The primary objective of this study was to transadapt the aging voice index (AVI) in Bengali (AVI-B) for the Bengali population to help in better comprehension by the patient rating the AVI scale. Ten older adults with voice disorder were asked to fill the AVI-E and AVI-B simultaneously to check the homogeneity of AVI-B. Establishment of kappa co-efficient between AVI-E and AVI-B was done. Wilcoxon test was done to evaluate the differences between pre and post therapeutic results. Kappa correlation for content validity was 0.81. The parameters of doctor speech, grade of grade, roughness, breathiness, asthenia, strain, and instability (GRABASI) scale and voice handicap index (VHI)-10 scale were mild to moderately correlated to the AVI-B (p>0.05). Inter class correlation for test-retest reliability was 0.933. Pre to post AVI-B scores were reduced when the participants were given a period of straw phonation therapy treatment. The AVI-B is a valid and reliable quality of life assessment for older adults with voice disorder and with native language as Bengali.

Utilizing video laryngoscopy before thyroidectomy in a hospital in Mangalore

Manisha N. — 2024-11-26

The highly debated opinion of whether a pre-operative video laryngoscopy was necessary to both patient care and doctor safety would be answered by the clinical insight into a local hospital who’s standard of care involves performing a video laryngoscopy before any major thyroid surgery. Aims and objectives of the study were to improve patient care and quality of life and ensure appropriate and proper investigation of the patient. Record based retrospective study assessing all patients that came for thyroidectomy during the time period from January 2022 to December 2022. 100% of patients who came to our hospital with any indication of thyroidectomy underwent video laryngoscopy preoperatively. We recommend video laryngoscopy (VLS) to be done in a 100% of cases of patients posted for thyroidectomies in the near future as it benefits both the patient and the doctor.

Evaluating the types of osteotomies performed in rhinoplasty

Nikita Iyer — 2024-11-26

Nasal bone osteotomies are essential in rhinoplasty, particularly in the context of India where rhinoplasty is a prevalent aesthetic procedure. These osteotomies serve various purposes, from widening a narrow nasal bony pyramid to correcting deviations or width issues. Beyond routine cases, congenital, traumatic, or developmental deformities may require unique approaches to address nasal bone structure. However, consensus on the optimal osteotomy technique remains elusive. The ideal technique should be precise, reproducible, safe, and minimize postoperative complications like bruising and swelling. This study focuses on identifying the most commonly used osteotomy technique in rhinoplasty that yields favorable results. This retrospective study spanned from January 2021 to July 2023 and included 60 patients undergoing rhinoplasty. Preoperative data were documented, intraoperative methods were recorded, and postoperatively, the prevalence of different osteotomy types was statistically analyzed. Among the 60 patients, 70% (42 patients) underwent combined medial and lateral osteotomies. Within this group, 12 patients had lateral osteotomies using the high-to-high method, 5 patients had the low-to-low method, and 25 patients had the high-to-low lateral osteotomy. This study underscores the critical role of osteotomy in rhinoplasty. A retrospective analysis of 60 rhinoplasty cases revealed that the lateral osteotomy high-to-low method is the most commonly employed technique. This finding suggests that this particular approach is favored by surgeons for its effectiveness in achieving the desired outcomes in rhinoplasty procedures.

Echoes of mumps: exploring sensorineural hearing loss

Trisha Srivastava — 2024-11-26

To investigate the role of intratympanic steroids and hyperbaric oxygen therapy in treating sudden sensorineural hearing loss (SSNHL) following acute viral mumps illness. Mumps is commonly associated with fever, headache, muscle aches, and parotid gland swelling but can also lead to severe complications such as SNHL, resulting from inner ear or auditory nerve damage. Eight cases of sudden-onset SSNHL of severe to profound nature presented in our OPD. Two patients were under 15 years old, and the rest were middle-aged. Treatment included oral steroids, antibiotics, and intratympanic steroids (injection methylprednisolone). Despite regular PTA evaluations, none of the patients showed improvement in hearing loss. The actual number of mumps cases is hard to determine, as many may not seek medical attention, and clinical diagnosis can be inaccurate. The incidence of mumps-related deafness is uncertain and often unilateral, which can be overlooked. If deafness develops later, identifying the cause can be challenging. The widespread use of the MMR vaccine has significantly reduced mumps incidence and related health issues, including SSNHL. Vaccination protects individuals and contributes to herd immunity, lowering disease prevalence.

A case series on post-auricular swellings: varied lesions with similar presentations

Elton Mendonca — 2024-11-26

The post-auricular region presents with swellings that can arise from various aetiologies. Attention to this region is lower as it is generally a cosmetically insignificant area and also most swellings from this region are slow growing. However, literature gives an account of inflammatory as well as neoplastic growths from this area with some masses being malignant in nature. In this case series, we report three patient who had symptomless, slow growing swellings behind their ear in the post-auricular region which were similar on examination. However, all three masses were reported of different diagnoses on their histopathology report. This brings to light the importance of timely investigation and treatment of swellings of the post-auricular region.