International Journal of Otorhinolaryngology and Head and Neck Surgery

Methods, complications and chemical paradigms for intra-aural tick removal (otoacariasis) – a systematic review of evidence and regional protocol for the Western Himalayan region

Avinav Sarmaik — 2026-09-25

Human otoacariasis is the infestation of the external auditory canal (EAC) by ticks which presents an acute otological emergency common to agricultural zones like Himachal Pradesh. Historical clinical custom relies on topically instilling local anaesthetics (lignocaine) before mechanical extraction. However, international laboratory data challenges this technique's biological efficacy. The objective of the study was to systematically review extraction methods, clinical profiles, and chemical reagent efficacies in human otoacariasis, proposing a validated protocol that reconciles traditional Indian practices with controlled experimental data. A systematic literature search of PubMed, Embase, Scopus, and the Cochrane library was conducted following PRISMA 2020 guidelines. Eligible papers focused on human intra-aural tick extraction within India or laboratory data directly evaluating chemical agent timelines on ear canal ticks. Data from pooled regional clinical cohorts (over 230 consolidated cases) show that blind mechanical extraction without chemical assistance increases the risk of tympanic membrane (TM) perforation and retained mouthparts. Experimental literature reveals that 4% lidocaine fails to kill or detach ticks (100% survival after 20 minutes). Instead, acetone achieves rapid acaricidal inactivation (mean nymph death: 185.1 seconds) but presents risks of ototoxicity if the eardrum is perforated. The perceived clinical utility of lignocaine drops stems from numbing the sensitive human ear canal rather than direct effects on the tick. For areas with limited resources like rural Himachal Pradesh, a two-tiered clinical protocol using safe chemical agents followed by microscopic or endoscope-assisted removal is recommended.

False tract during tracheostomy tube insertion: a review

Manish Munjal — 2026-09-25

Tracheostomy a surgical intervention, emergency or elective in non-ambulatory and upper airway compromised individuals. The utility of this procedure is twofold i.e. tracheo -bronchial toilet in the former and mechanical ventilation by bypassing the upper respiratory tract, in the latter. The simple surgery is sometimes fraught with unexpected complications and consequent significant morbidity and mortality. The likelihood is more so in the pediatric age group, where the trachea is pencil thin almost equal vent to the carotids in its diameter. Incorrect insertion of tracheostomy tube with, a consequent false tract and thereby a mal - positioned ventilation circuit, is a malady with likelihood of untoward consequences and thereby significant morbidity and mortality. This review highlights the utility of appropriate technique, early recognition, and remedial interventions in these false tracheostomy tracts. The etiology, diagnosis, complications and medical or surgical management with recent advances in prevention and treatment strategies shall be emphasized upon.

Symptom-based clinical and tympanometric assessment of Eustachian tube dysfunction

Prerana Dani — 2026-08-13

Background: Eustachian tube dysfunction (ETD) is a clinically important disorder that impairs middle-ear ventilation, pressure equalization, and mucociliary clearance. It contributes to otologic symptoms such as ear fullness, hearing impairment, tinnitus, and pain, and may predispose to chronic middle-ear pathology. Despite its practical importance, the burden of ETD in symptomatic outpatient populations remains under-reported, particularly in hospital-based Indian settings. Aim of the study was to evaluate the clinical profile, tympanometric findings, associated factors, and independent predictors of ETD in symptomatic patients attending a tertiary care ENT outpatient department.

Methods: This hospital-based cross-sectional study included 384 symptomatic patients. Clinical history, symptom assessment, ETDQ-7, and tympanometric evaluation were used for assessment. Statistical analysis included descriptive statistics, Chi-square testing, and multivariate logistic regression, with p<0.05 considered significant.

Results: ETD was present in 168 of 384 patients (43.8%). The mean age was 28.14±6.80 years, and the largest age group was 21–30 years. Males constituted 60.9% of the study population. Significant symptom associations were observed for aural fullness, hearing loss, tinnitus, and ear pain. Clinical factors significantly associated with ETD included allergic rhinitis, upper respiratory tract infection, chronic sinusitis, deviated nasal septum, smoking, and adenoid hypertrophy, while GERD was not statistically significant. On multivariate analysis, the strongest predictors were type B/C tympanogram (adjusted OR 8.92), hearing loss (adjusted OR 6.48), and aural fullness (adjusted OR 5.12).

Conclusions: ETD is highly prevalent among symptomatic ENT outpatients. Aural fullness and hearing loss are the most useful clinical indicators, while abnormal tympanometry provides the strongest objective support for diagnosis. A combined symptom-based and tympanometric approach is essential for early recognition and appropriate management of ETD in routine practice.

Clinical profile and associated risk factors of chronic suppurative otitis media in a tertiary care centre: a cross-sectional study

Tanisha Dhanelia — 2026-08-05

Background: Chronic suppurative otitis media (CSOM) remains a major cause of preventable hearing loss in low- and middle-income countries and is closely associated with poverty, overcrowding, recurrent upper respiratory infection, undernutrition and delayed access to treatment. To evaluate the clinical profile and associated risk factors of CSOM in patients attending a tertiary care centre.

Methods: This hospital-based cross-sectional observational study included 384 patients with clinically diagnosed CSOM. Data were collected using a predesigned semi-structured proforma incorporating demographic characteristics, symptom profile, otoscopic findings, associated ENT conditions, hearing assessment and environmental or behavioural risk factors. Statistical analysis included descriptive statistics and multivariate analysis to identify independent predictors of severe disease.

Results: The mean age of patients was 31.32±10.31 years, with the largest proportion belonging to the 31–40 years age group. Mucosal chronic otitis media was the predominant type (60.41%), while squamosal disease accounted for 39.1% of cases. Cholesteatoma was present in 44.74% of patients. Ear discharge (89.1%) and hearing loss (77.6%) were the most common presenting complaints. Conductive hearing loss was the commonest audiological pattern (71.88%). Low socioeconomic status, malnutrition, bottle feeding, overcrowding, indoor cooking exposure and upper respiratory tract infection showed significant association with severe disease. On multivariate analysis, low socioeconomic status, malnutrition, bottle feeding, overcrowding and indoor cooking exposure remained independent predictors of squamosal disease.

Conclusions: CSOM in this tertiary care population showed a substantial burden of hearing loss and unsafe disease. Severe disease was strongly associated with modifiable social and environmental determinants, highlighting the need for early diagnosis, hearing assessment, management of associated upper airway disease and preventive community-level interventions.

An outcome evaluation of 360-degree subannular tympanoplasty for subtotal and anterior tympanic membrane perforations: a prospective observational study from Eastern India

Kailash Prasad Verma — 2026-08-18

Background: Subtotal and anterior tympanic membrane (TM) perforations remain a surgical challenge as the anterior tympanomeatal angle is prone to blunting, graft lateralization and residual perforation with conventional underlay tympanoplasty. This study evaluated the anatomical and functional outcomes of 360° subannular tympanoplasty in such perforations at a tertiary care centre in Eastern India.

Methods: This prospective observational study enrolled 52 patients aged 12-70 years with subtotal or anterior TM perforation, dry middle ear, normal middle ear mucosa, intact ossicular chain and no cholesteatoma, at our institution, a tertiary care centre in Eastern India, between June 2023 and May 2025. Patients with prior ear surgery or head-neck radiotherapy were excluded. All patients underwent 360° subannular tympanoplasty by a postaural, microscopic approach using a temporalis fascia graft, with anatomical and audiometric follow-up at 6 and 12 months. Data were analysed using the paired t test.

Results: The mean age was 45.9±10.4 years; 25 patients (48.1%) were male and 27 (51.9%) were female. Anatomical success was 92.0% at 6 months and 98.1% (51/52 ears) at 12 months. Mean air-bone gap (ABG) improved from 44.2±10.4 dB preoperatively to 14.3±8.3 dB postoperatively (p<0.001). ABG closure to ≤20 dB was achieved in 43/52 ears (82.6%). Granulations occurred in 4 ears (7.6%) and residual perforation in 1 ear (1.9%, 95% CI=0.3-10.1%); no graft medialization, lateralization or anterior blunting occurred.

Conclusions: The 360° subannular tympanoplasty is a reliable technique for subtotal and anterior TM perforations, providing a high graft uptake rate, significant hearing improvement and a low complication rate.

Functional audiological outcomes of canal wall down mastoidectomy with type III tympanoplasty in middle ear and mastoid cholesteatoma

Abhishek Manjunath — 2026-08-13

Background: Cholesteatoma is a destructive middle ear disease requiring surgical intervention. Canal wall down mastoidectomy (CWDM) combined with type III tympanoplasty is commonly performed to eradicate disease and restore hearing. Objective of the study was to evaluate hearing outcomes and graft uptake in patients undergoing CWDM with type III tympanoplasty.

Methods: A prospective clinical study was conducted on 77 patients with attico-antral chronic suppurative otitis media. All patients underwent CWDM with type III tympanoplasty. Preoperative and postoperative hearing levels and air-bone gaps (ABG) were compared using the Wilcoxon signed-rank test.

Results: The median preoperative hearing loss improved from 43.75 dB to 31.25 dB postoperatively (p<0.001). Median ABG reduced from 22.5 dB to 8.75 dB (p<0.001). ABG closure of 10–19.9 dB was seen in 55.8% of patients.

Conclusions: CWDM with type III tympanoplasty provides significant hearing improvement along with effective disease eradication.

Bengal's Dhakis: awareness and impact of long-term noise exposure

Akash Mandal — 2026-09-25

Background: The hazards of occupational noise exposure among musicians are extensively studied globally, yet remain rare in the Indian setting, particularly for indigenous rural musicians like Bengal's Dhakis.

Methods: This observational, cross-sectional study aimed to assess the knowledge, attitudes, practices, and objective impact of noise exposure in this community. Conducted in Hadal Narayanpur, Bankura in October 2023, the study included 168 male musicians working for more than five years. Data was collected via a one-to-one interview utilizing a pre-tested questionnaire. Screening audiometry was performed using a manually calibrated Android application.

Results: The mean age of participants was 33.5 years. While 80.4% (n=135) believed prolonged loud noise exposure causes irreversible hearing loss, only 7.1% (n=12) had ever used hearing protection. Following intervention, 76.8% (n=129) expressed willingness to use protection. Subjectively, hearing difficulty was prevalent in 42.9% (n=72) and 78.6% (n=132) experienced tinnitus post-event. Objective screening audiometry revealed that 37.5% (n=63) had mild or greater hearing loss.

Conclusions: There is an alarming lack of awareness and severe underutilization of hearing protection among Dhakis. The high incidence of hearing impairment necessitates urgent public health interventions to provide inexpensive hearing protectors and preserve this culturally vital community's auditory health.

Temporal divergence in symptom relief after submucosal diathermy versus endoscopic partial inferior turbinectomy – a prospective randomized study in a central Indian tertiary care cohort

Harsh N. Joshi — 2026-09-25

Background: Inferior turbinate hypertrophy (ITH) is the commonest structural cause of chronic nasal obstruction. Submucosal diathermy (SMD) and endoscopic partial inferior turbinectomy (EPT) are both widely used, but their comparative outcome over time is incompletely characterized.

Methods: In this prospective, randomized, single-centre study, 100 adults with bilateral grade II-IV ITH refractory to medical therapy were randomized to SMD (n=50) or EPT (n=50). The nasal obstruction symptom evaluation (NOSE) score was recorded pre-operatively and at day 7, 1, 3 and 6 months; complications and operative time were recorded. t-tests and Chi-square/Fisher’s exact test were used; p<0.05 was taken as significant.

Results: Groups were comparable for baseline NOSE score (74.10±8.19 versus 75.14±9.57; p=0.56). Improvement was equivalent at Day 7 (p=0.72) and 1 month (p=0.25). A significant divergence favouring EPT emerged at 3 months (31.32±5.42 versus 22.50±4.72; p<0.0001) and consolidated at 6 months (33.92±5.98 versus 7.54±2.53; p<0.0001), a 54.22% versus 89.97% reduction from baseline. EPT had greater early morbidity, including bleeding in 76% versus 2% of patients at Day 3, but every complication was self-limiting. Operative time was shorter with SMD (18.6±3.4 versus 27.8±5.1 minutes; p<0.0001). No atrophic rhinitis or empty nose syndrome occurred.

Conclusions: SMD and EPT gave equivalent short-term relief, but outcomes diverged from three months onward: SMD relapsed while EPT produced durable, near-complete resolution at the cost of transient early morbidity. Technique selection should be individualized to the patient and the predominant component of hypertrophy.

Dental compensations with changes in skeletal transverse dimensions: myth or reality

Amit Antil — 2026-09-25

Background: Orthodontic treatment aims to harmonize functional and aesthetic aspects of the dentofacial complex, with emphasis on molar inclinations and maxillary transverse dimensions. These parameters, evaluated across sagittal, vertical, and transverse planes, are essential for accurate diagnosis and treatment planning to achieve stable occlusion. This study assessed the correlation between maxillary and mandibular molar inclinations and skeletal transverse dimensions in a mixed Indian population using cone beam computed tomography (CBCT) analysis.

Methods: A retrospective, cross-sectional study was conducted on 50 pre-treatment CBCT scans (27 males, 23 females; mean age 19.8 years). Molar inclinations and transverse skeletal dimensions were measured using NNT software. Pearson’s correlation coefficient was applied to evaluate relationships between variables.

Results: The mean mandibular transverse dimension (62.00±6.94 mm) exceeded the maxillary transverse dimension (60.61±4.29 mm). Mean inclinations of the right and left maxillary first molars with the occlusal plane were 79.49°±4.69° and 81.44°±5.71°, respectively, while mandibular first molars showed 106.47°±16.08° (right) and 103.26°±6.20° (left). A significant positive correlation existed between maxillary and mandibular transverse dimensions (r=0.40, p=0.003). The mandibular transverse dimension showed significant negative correlations with right (r=-0.53, p=0.00) and left (r=-0.42, p=0.02) maxillary molar inclinations. Other correlations were non-significant.

Conclusions: Findings indicate a significant relationship between mandibular transverse dimension and maxillary molar inclination. While maxillary molar inclination showed weak correlation with skeletal transverse dimensions, the results highlight the importance of considering transverse skeletal parameters in orthodontic diagnosis and treatment planning.

A study comparing conventional septoplasty with endoscopic septoplasty

Bhaskar Gayen — 2026-09-25

Background: Endoscopic septoplasty provides direct visualization of septal pathology and may be particularly useful for posterior deviations and as an adjunct to endoscopic sinus surgery. This prospective comparative study evaluated the technical and post-operative outcomes of endoscopic and conventional septoplasty.

Methods: Fifty patients with significant symptomatic deviated nasal septum were studied prospectively at the Department of ENT, Head and Neck Surgery, Command Hospital (Eastern Command), Kolkata. Twenty-five patients underwent endoscopic septoplasty and 25 underwent conventional septoplasty. Patient symptoms, intraoperative visualization, operative time, blood loss, flap injury, early postoperative bleeding, nasal toilet, pain, postoperative complications and relief of nasal obstruction were assessed. Comparisons were performed using the Chi-square test, with p<0.05 considered statistically significant.

Results: Endoscopic septoplasty provided better visualization of the posterior septum (100% versus 72%; p=0.0312) and superior septum (100% versus 68%; p=0.0188). Mean operative time was 52 versus 48 minutes (p=0.777), and intraoperative blood-loss categories did not differ significantly (p=0.230). No flap tear occurred in 80% of endoscopic cases versus 44% of conventional cases (p=0.009 for absence of tears). Early postoperative pack-change requirement (p=0.439), nasal toilet (p=0.315), pain (p=0.697), synechiae (p=0.427) and relief of nasal obstruction (76% complete versus 68%; p=0.325) were not significantly different. Septal haematoma occurred in one conventional case and in none of the endoscopic cases; no septal abscess or perforation occurred.

Conclusions: Endoscopic septoplasty demonstrated technical advantages in visualization and flap preservation, particularly for posterior or limited septal pathology. Overall postoperative symptom relief and complications were broadly comparable between techniques. Conventional septoplasty remains useful for large, caudal and complex deviations.

Surgical removal of angiofibroma under hypotensive anesthesia: a retrospective report

Shiv Kumar — 2026-09-25

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor where surgical excision is often complicated by significant intraoperative hemorrhage. While preoperative embolization can reduce bleeding, it is not always available. Induced hypotension is an alternative technique to minimize blood loss.

Methods: We conducted a retrospective review of 62 patients who underwent surgical resection of JNA (without intracranial extension) from March 2010 to December 2025. Patients were divided into three groups: group I (normotensive anaesthesia, n=21), group II (hypotensive anaesthesia induced with propofol and halothane, n=21), and group III (hypotension induced with intravenous nitroglycerine infusion, n=20). The primary outcome measured was intraoperative blood transfusion requirements.

Results: The mean intraoperative blood transfusion requirement was lower in the hypotensive groups (3.2 units in group I vs approximately 1.75 units in groups II and III).

Conclusions: Induced hypotensive anaesthesia was associated with lower reported intraoperative blood transfusion requirements and can be used safely as an alternative to preoperative embolization during surgical resection of JNA.

A comparative study of long term average spectrum measures on spontaneous speech tasks between patients with Parkinson’s disease and age matched normals

Puranjit Kar — 2026-09-25

Background: Long term average spectrum (LTAS) is a robust tool in assessing voice characteristics over a period of time. Individuals with Parkinson’s disease (PD) exhibit speech impairments, which includes monopitch and monoloudness, reduced stress, tremulous voice and inappropriate silences. Since, there are no studies in Indian context to analyse the spontaneous speech of patients with PD through LTAS and spontaneous speech provides naturalness in speech, the present study is an attempt to compare spontaneous speech between patients with PD and age matched normals using LTAS.

Methods: A total of 30 participants aged 50-70 years were considered for the study among which 15 were patients with PD (group-I) and 15 were age matched normals (group-II). The LTAS parameters - mean spectral energy (MSE), first spectral peak (FSP), spectral tilt (ST), three spectral slope (SS) measures (SSF0-1kHz, SS1-5kHz, and SS ratio), four spectral moment analysis (mean, standard deviation, skewness, and kurtosis), jitter and shimmer were taken for analysis. Mann-Whitney U test was performed for statistical analyses.

Results: The results showed there was significant difference in mean values of MSE, FSP, ST, four SM measures, jitter and shimmer. However, there was no significant difference in mean values of three SS measures.

Conclusions: To conclude the study it can be said that patients with PD demonstrate specific LTAS characteristics that are different from normals.

Quality of life after septoplasty in patients with nasal obstruction – a prospective observational study

Ravi Kishore Hubballi — 2026-09-25

Background: Nasal septum deviation is most common cause of nasal obstruction. Septoplasty is most commonly done surgery for deviated nasal septum. At present the effectiveness of septoplasty in patients with nasal obstruction due to a deviated nasal septum remains uncertain. The outcome of the procedure is essential for the surgeon and patient to make an appropriate decision on the plan of management. Hence this study is undertaken to evaluate patients at different postoperative follow up intervals using nasal obstruction septoplasty effectiveness scale (NOSE) to know the efficacy of septoplasty.

Methods: Fifty patients with nasal obstruction due to deviated nasal septum were included in our study. All the patients answered NOSE questionnaire preoperatively and at 1, 3 and 6 months after septoplasty.

Results: The mean preoperative NOSE Score of 71.4±15.1 reduced to 2.5±3.5 at 6 months after septoplasty indicating improvement in the symptoms. Nasal congestion and nasal obstruction were completely eliminated from majority of the patients. Furthermore, breathing troubles and sleeping troubles had completely disappeared in 98% patients by 6 months in the postoperative period. Exercise problems had completely disappeared postoperatively in all patients.

Conclusions: The preoperative NOSE scores reduced significantly in the postoperative period. Septoplasty is a relieving surgery for patients with symptomatic deviated nasal septum, who are suffering from nasal congestion, nasal blockage, trouble breathing, trouble sleeping and exercise problems. Hence septoplasty results in improvement in the disease-specific quality of life of patients.

Patterns, triggers and relieving factors of pain in third molar pericoronitis: a cross-sectional study

Safura Z. Quazi — 2026-09-25

Background: Pericoronitis is a common inflammatory with pain being one of its most prominent clinical manifestations. Yet, the specific characteristics and patterns of pain associated with pericoronitis remain relatively underexplored. This study aimed to assess the pattern of pain associated with pericoronitis in the third molar region.

Methods: A cross-sectional observational study was conducted among 359 patients with third-molar pericoronitis. Data were for type, onset, severity, aggravating factors, relieving factors and clinical symptoms was collected. Clinical and radiographic examination was performed to confirm the presence and eruption status of the affected third molar.

Results: Throbbing pain was the most commonly reported pain type (49.86%), followed by dull (29.81%) and sharp pain (20.33%). Pain onset was predominantly gradual (74.37%).

Eating hard food was the most frequently reported factor aggravating pain (42.34%), followed by poor oral hygiene (28.69%). Moderate pain was the most common severity grade (48.47%), followed by mild (31.20%) and severe pain (15.32%). Avoiding chewing on the affected side was the most frequently reported relieving measure (43.25%).

Conclusions: Pain associated with third-molar pericoronitis predominantly presented as gradually developing, throbbing, and moderate in severity. Mastication, particularly eating hard food was the most common aggravating factor while avoidance of chewing on the affected side was the most frequently reported relieving measure.

Echoes of neglect – the pediatric burden of chronic otitis media

Prankul Khandelwal — 2026-09-25

Background: Chronic otitis media (COM) is a major cause of morbidity among children, particularly in developing regions, where socioeconomic and environmental factors contribute to its high prevalence. This study aimed to evaluate the prevalence, clinical profile, predisposing factors, and management of COM among pediatric patients.

Methods: This cross-sectional, hospital-based study was conducted over one year (April 2025-March 2026) in the ear, nose, and throat (ENT) outpatient department. A total of 200 pediatric patients aged 5-15 years diagnosed with COM were enrolled. Demographic characteristics, clinical presentation, and predisposing factors were recorded using a structured questionnaire. All patients underwent otoscopic examination and tuning-fork tests. Data were analyzed using statistical package for the social sciences (SPSS).

Results: Of 1,740 pediatric patients screened, 200 were diagnosed with COM, giving a hospital-based prevalence of 11.49%. There was a male predominance, with a male-to-female ratio of 1.44:1. The highest proportion of cases occurred in the 8-10-year age group. Ear discharge was the most common symptom (72%), followed by ear pain (14%) and hearing loss (12%). Unilateral disease predominated, and central tympanic membrane perforation was the most frequent otoscopic finding. Objective hearing impairment was detected in 68 patients (34%) and showed a significant association with the duration of symptoms (p<0.05). Management was predominantly medical, including antibiotics, topical ear drops, and nasal decongestants.

Conclusions: Pediatric COM remains a significant cause of morbidity and hearing impairment. Modifiable factors such as poor hygiene and bathing in open ponds highlight the need for community awareness, health education, and improved living conditions in rural areas. Early diagnosis and appropriate treatment are essential to prevent long-term complications.

A structured data header for neck dissection documentation: a feasibility proposal for surgical reporting

Manu C. Balakrishnan — 2026-09-25

Every neck dissection tells a story. The surgeon's operative note captures that story in prose-which structures were preserved, which were sacrificed, and why. For decades, this narrative tradition has served clinicians well. These operative notes are useful not just for the surgeons or patients but also are used for audit, research, coding and digital analysis. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification and terminology of the Modified Radical Neck Dissection (MRND) is widely accepted worldwide primarily because it contains all the relevant information which will aid in the communication and rehabilitation of the patient. However, it also has a drawback in which effective communication cannot be achieved without detailed wordings and we also had this practical discussion in the operating theatre while teaching the post graduate residents.

A rare case of a spindle handle and malleus bar without deformities of the external ear: a case report and literature review

Mitsuhiro Aoki — 2026-09-25

Congenital fixation of the malleus and incus is an uncommon cause of conductive hearing loss. The malleus bar, characterized by a bony bridge from the malleus neck to the posterior annulus, presents diagnostic challenges preoperatively due to its subtle radiological features. A 9-year-old boy visited our hospital with hearing loss as his main complaint with autism spectrum disorder. The left tympanic membrane lacked identifiable structures such as the short process or umbilicus, and the malleus appeared rod-shaped, oriented anteriorly. Intraoperative findings confirmed a bony cord extending from the posterior wall of the tympanic cavity to the malleus, with the chorda tympani nerve running parallel. The malleus exhibited restricted mobility due to the malleus bar, which was easily severed, leading to enhanced ossicular mobility and hearing improvement. Histopathological analysis confirmed the bony composition of the excised tissue. Postoperative audiometry indicated a reduction in hearing loss, although a residual air-bone gap persisted. This report presents a rare case involving a spindle-shaped malleus handle and malleus bar in the middle ear, occurring without external ear deformities, emphasizing the importance of detailed anatomical assessment.

Surgical modification for redo mastoidectomy in the presence of a large postauricular keloid: a case report and literature review

Alex Z. J. Ho — 2026-09-25

Postauricular keloids may complicate mastoid surgery by obscuring landmarks, restricting flap mobility, and increasing recurrence risk. Their presence demands surgical modifications to ensure both safe disease clearance and stable wound healing. A 19-year-old male from a Malaysian indigenous tribe presented with recurrent cholesteatoma and a large postauricular keloid (8×3 cm) following prior mastoidectomy. The keloid limited access and distorted anatomy. Steroid injections were ineffective. A single-stage redo modified radical mastoidectomy with type IV tympanoplasty, meatoplasty, and keloid excision was performed. Elliptical incision, wide undermining, meticulous hemostasis, layered closure, and mastoid bandaging achieved tension-free healing. At six months, the ear remained dry without recurrence of cholesteatoma or keloid. Single stage mastoidectomy with keloid excision is feasible. Careful surgical technique with simple measures such as wide undermining and compression bandaging may obviate the need for adjuvant therapy in selected patients.

Chronic migraine unmasking invasive sinonasal aspergillosis: a delayed diagnosis with skull-base and cavernous sinus extension: a case report

Zohad Fareh — 2026-09-25

Invasive aspergillosis (IA) is rare infection, primarily affecting immunocompromised hosts. We report a rare case of IA in an apparently immunocompetent 54-year-old woman, initially misdiagnosed and treated as migraine due to headache and diplopia. We reviewed the patient’s clinical presentation, imaging studies (Computed tomography [CT] and Magnetic resonanace imaging [MRI]), surgical intervention, antifungal therapy, and postoperative course. Diagnostic criteria included radiologic evidence of sinus mass with bone erosion and histopathologic confirmation following functional endoscopic sinus surgery (FESS). Treatment complications were monitored through serial laboratory tests and clinical assessments. CT demonstrated bone erosion of the left maxillary sinus; MRI showed a T1-hyperintense, T2-hypointense lesion with peripheral rim enhancement. The patient underwent FESS with complete debridement. Postoperatively, voriconazole was administered according to standard dosing protocols. The patient developed syndrome of inappropriate antidiuretic hormone secretion (SIADH), which was promptly recognized and managed with fluid restriction and salt supplementation. Full remission was achieved, with resolution of neurological symptoms and normalization of sodium levels. This case underscores that IA can occur in patients without overt immunosuppression and may mimic benign neurologic conditions. Early consideration of fungal etiologies in refractory “sinus-related” neurological presentations, combined with targeted imaging and prompt surgical and antifungal therapy, can lead to favourable outcomes.

Status vestibular migrainosus as a cause for acute vestibular syndrome

Maanasa P. Seshagiri — 2026-09-25

Acute vestibular syndrome (AVS) is characterized by sudden-onset, continuous vertigo lasting more than 24 hours, accompanied by nausea, vomiting, and worsening with head movement. Common etiologies include vestibular neuritis, labyrinthitis, and posterior circulation stroke. Because of overlapping neurovascular supply, peripheral and central vestibular disorders can share clinical signs such as hearing loss, nystagmus, abnormal vestibulo-ocular reflex (VOR), and unstable gait. Status vestibular migrainosus, an extended episode of vestibular migraine (VM) with persistent vertigo and disequilibrium for over 24 hours-may mimic AVS and is often difficult to distinguish from vestibular disorders. We report a patient with status vestibular migrainosus whose features mimicked AVS. The clinical picture fulfilled the diagnostic criteria for AVS, with features typically attributed to peripheral vestibular pathology. Comprehensive evaluation, however, supported a diagnosis of status vestibular migrainosus, highlighting the diagnostic challenge posed by overlapping peripheral and central vestibular signs. Status vestibular migrainosus can present as AVS and closely resemble peripheral vestibular disorders. Awareness of this entity and careful clinical assessment are critical to avoid misdiagnosis and prompt recognition is essential for accurate management and prognosis.

A life interrupted by stuttering and reclaimed through therapy: a case report

Shiwalika Verma — 2026-09-25

Stuttering is a communication disorder characterized by repetitions, prolongations, and blocks that disrupt the normal flow of speech. Beyond these overt speech disruptions, individuals who stutter often experience emotional, cognitive, behavioral, and social difficulties that affect their overall quality of life. This case report describes the assessment and therapeutic management of a 27-year-old male with persistent developmental stuttering. A comprehensive evaluation, including case history, fluency assessment, and psychosocial profiling, was conducted to develop an individualized intervention plan. Therapy incorporated fluency-shaping techniques, stuttering modification strategies, relaxation exercises, counseling, and home practice. Following intervention, the client demonstrated improved speech fluency, reduced dysfluencies, increased confidence, enhanced communication participation, and better overall psychosocial functioning.

Hereditary hemorrhagic telangiectasia presenting with severe nasal bleeding: an ENT perspective

Ankur Gupta — 2026-09-25

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu syndrome, is a rare autosomal dominant vascular disorder characterized by mucocutaneous telangiectasia and visceral arteriovenous malformations. Recurrent epistaxis is the most common and often the earliest manifestation, frequently bringing patients to the otorhinolaryngologist. We report a case of a patient presenting with recurrent, spontaneous, and progressively severe nasal bleeding. Anterior rhinoscopy and diagnostic nasal endoscopy revealed multiple, discrete, bilateral telangiectatic lesions over the nasal septum, floor of the nasal cavity, and inferior turbinates, which bled on touch, making cauterization difficult at certain sites. Mucocutaneous telangiectasia over the lips and oral cavity with a positive family history supported the diagnosis. Based on clinical findings and established diagnostic criteria, a diagnosis of definite Hereditary Hemorrhagic Telangiectasia was made. The patient was managed with local nasal measures and supportive therapy. This case highlights the importance of early recognition of HHT by ENT specialists to enable timely diagnosis, appropriate management, and prevention of systemic complications.

Pleomorphic adenoma of the hard palate: a case report

Yeseera Alavudeen — 2026-09-25

Pleomorphic adenoma is the most common benign salivary gland tumor. It is a mixed tumor composed of epithelial and myoepithelial cells arranged in various morphological patterns and is usually demarcated by a fibrous capsule from surrounding tissues. While it commonly affects major salivary glands, its occurrence in minor salivary glands is less frequent. It shows a female predominance (60%) compared to males (40%). We report a case of a 45-year-old male patient, a driver by occupation, with a history of smoking, alcohol intake, and tobacco chewing for 25 years. He presented with a painless swelling over the hard palate for the past 2 years. Clinical examination and investigations led to a provisional diagnosis of pleomorphic adenoma of the minor salivary glands of the hard palate. The lesion was treated with wide local excision under local anesthesia. The excised specimen was sent for histopathological examination for definitive diagnosis. Histopathological examination confirmed the diagnosis of pleomorphic adenoma. The patient had an uneventful postoperative recovery with good healing. The palatal defect was allowed to heal by secondary intention, and satisfactory granulation with complete healing was observed. Pleomorphic adenoma of the minor salivary glands of the hard palate is a relatively rare entity but carries an excellent prognosis when treated with wide local excision. Definitive diagnosis depends on histopathological evaluation. Early diagnosis and adequate surgical management ensure good functional and cosmetic outcomes.

Chiari malformation type I: atypical vestibular presentation with down-beating nystagmus – a case report

Sanjay Helale — 2026-09-25

Arnold-Chiari malformation type I (CM-I) is a neurological disorder characterized by the caudal displacement of the cerebellar tonsils through the foramen magnum into the cervical spinal canal. The most common clinical manifestations include occipital headache and neck pain. However, vertigo is an uncommon presentation and may lead to diagnostic confusion with other vestibular disorders. A 39-year-old female presented with a ten-year history of occipitocervical pain accompanied by recurrent episodes of dizziness. Her symptoms clinically resembled cervicogenic dizziness for which she received treatment with minimal improvement. Further evaluation at a specialized center included videonystagmography, which demonstrated down-beating nystagmus. Magnetic resonance imaging (MRI) of the brain with craniovertebral junction assessment subsequently revealed herniation of the cerebellar tonsils consistent with chiari malformation type I. This case highlights an atypical presentation of CM-I in which vestibular symptoms predominated, while the classic symptom of persistent occipital headache was less prominent. Such atypical manifestations can delay diagnosis and appropriate management. Comprehensive neuro-otological evaluation, including vestibular testing and neuroimaging, plays a crucial role in identifying central causes of vertigo. CM-I should be considered in the differential diagnosis of patients presenting with unexplained vertigo or vestibular symptoms, particularly when associated with occipitocervical pain. Early recognition and appropriate imaging are essential for timely diagnosis and management. Following diagnosis, the patient was planned for foramen magnum decompression surgery.

Cutaneous hamartoma overlying the frontal bone – a rare paediatric case report

Shivangi Manglik — 2026-09-25

Hamartomas are benign malformations composed of disorganized mature tissues native to their site of origin. Their occurrence in the supraorbital region is extremely rare and may mimic inflammatory or neoplastic lesions, leading to diagnostic challenges, particularly in paediatric patients. Aim of the study was to report a rare case of a supraorbital cutaneous hamartoma in a child, outlining the clinical features, diagnostic evaluation, surgical management, and histopathological confirmation. An 11-year-old female presented with a 9-month history of a tender, mobile swelling over the left supraorbital region. Clinical examination, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and routine laboratory investigations were performed. The lesion was excised surgically under general anaesthesia, and the specimen was sent for histopathological evaluation. Ultrasonography revealed a hypoechoic collection; CT identified a soft tissue swelling with a calcific fragment, while MRI showed mild local oedema without intracranial extension. Surgical excision revealed a cystic lesion containing a bony fragment. Histopathology demonstrated fibro adipose, fibromuscular, and fibro-collagenous tissues with vascular and neural bundles, confirming a hamartoma. The postoperative course was uneventful, with no recurrence noted at 4-week follow-up. Supraorbital cutaneous hamartomas are exceedingly rare in paediatric patients and may clinically resemble other benign or inflammatory lesions. A combination of imaging and histopathology is essential for accurate diagnosis. Complete surgical excision is curative and prevents recurrence. Long-term follow-up is advisable to monitor for late recurrence or syndromic associations.

Progressive external nasal destruction caused by presumed invasive sinonasal aspergillosis in an apparently immunocompetent infant: a case report

Mudit Mittal — 2026-09-25

Invasive sinonasal aspergillosis is a life-threatening infection classically seen in immunocompromised patients. It has occurred in infants with grade II protein-energy malnutrition without typical immunocompromising conditions. External cutaneous nasal extension further distinguishes this presentation from previously described paediatric cases. An 18-month-old girl with grade II protein-energy malnutrition presented with a 7-8-month history of progressive ulceration, crusting, and destruction of the external nose. Diagnostic nasal endoscopy under general anaesthesia revealed extensive black necrotic fungal debris within both nasal cavities. Histopathological examination of the biopsy specimen revealed slender septate fungal hyphae with acute-angle branching, consistent with Aspergillus species. There were no known immunocompromising conditions, although a full immunological workup was limited. The caregivers declined further evaluation and definitive treatment, and the child left against medical advice. This case demonstrates that presumed invasive sinonasal aspergillosis with external cutaneous extension can occur in infants even in the absence of known immunocompromising conditions. Early nasal endoscopy and prompt tissue biopsy are essential for timely diagnosis. Although grade II protein-energy malnutrition may have contributed to host susceptibility, its causal role cannot be established from a single case.

Intratympanic steroids as primary treatment for sudden sensorineural hearing loss

Soumick Ranjan Sahoo — 2026-09-25

Sudden sensorineural hearing loss (SSNHL) is an otological emergency which demands immediate treatment. It is a rare condition which goes unnoticed because of lack of awareness about this condition among the people and healthcare professionals. SSNHL is considered to be idiopathic but some researchers have reported viral infections, vascular insufficiency, intra labyrinthine membrane rupture etc. as possible etiologies. There are various treatments modalities described in literature such as are steroids, antivirals, vasodilators, hyperbaric oxygen therapy etc. Steroids are one of the most common treatment modalities used for SSNHL. Intratympanic administration of steroids is beneficial because they help in hearing loss recovery while bypassing the side effects of systemic steroids. Our study is a retrospective study of the 15 cases of SSNHL treated by intratympanic steroids in the ENT Department of Burnpur Hospital from 2022-2025. The study reported more number of males with SSNHL. Most of the cases were seen in the age group of 61-70 years. Hearing recovery was seen in 73.3% of the cases. It is concluded that Intratympanic administration of steroids are a novel modality of treatment for cases of SSNHL and awareness of this condition must be created among the public and medical practitioners.

Spontaneous cerebrospinal fluid leak in a resource-limited setting: diagnostic strategy and surgical outcomes without advanced imaging

Natasha Supartono — 2026-09-25

Spontaneous cerebrospinal fluid (CSF) leaks remain diagnostically challenging, particularly in resource-limited settings where access to Beta-2-transferrin testing and CT cisternography is restricted. The objective was to describe the clinical characteristics, diagnostic approach, and surgical outcomes of spontaneous CSF leaks managed without advanced diagnostic modalities in a tertiary referral centre in Indonesia. A retrospective case series was conducted on six patients diagnosed with spontaneous CSF leak between 2023 and 2025. Diagnosis was established using clinical evaluation, nasal endoscopy, bedside testing, and high-resolution computed tomography (HRCT). Surgical repair was performed using endoscopic techniques. Clinical outcomes and postoperative complications were evaluated. The majority of patients were middle-aged females (83.3%) with elevated body mass index and associated comorbidities. Leak sites were predominantly located at the sphenoid sinus and cribriform plate, with meningoencephaloceles identified in four cases. Despite the absence of β2-transferrin testing and CT cisternography, HRCT combined with clinical assessment successfully localized defects. All patients underwent endoscopic repair with favorable outcomes, minimal complications, and short hospital stays. In resource-constrained settings, a structured diagnostic approach integrating clinical evaluation and HRCT can effectively guide management of spontaneous CSF leaks. Endoscopic repair remains a safe and effective treatment modality even in the absence of advanced diagnostic tools.

Otorhinolaryngological manifestations of haematological disorders: a case series of five patients

Mohan K. Mili — 2026-09-25

Haematological disorders frequently present with orofacial and ear, nose, and throat (ENT) manifestations, which may serve as the first clinical clue to an underlying condition. Recognizing these signs is essential for timely diagnosis and management. This paper presents a case series of five paediatric patients (aged 4-17 years) who presented with head and neck manifestations of previously undiagnosed or known haematological diseases, including postoperative bleeding, post-traumatic bleeding and spontaneous haemorrhage. Cases included mild haemophilia A diagnosed after adenotonsillectomy (case 1), post traumatic Christmas disease (factor IX deficiency) with extensive neck haematoma (case 2), known haemophilia A with refractory epistaxis requiring embolization (case 3), von Willebrand factor deficiency presenting as spontaneous bilateral epistaxis (case 4), and severe haemophilia A diagnosed after tongue laceration repair (case 5). All cases were successfully managed with factor replacement, fresh frozen plasma, desmopressin, or recombinant von Willebrand factor. Persistent, recurrent or unusual ENT symptoms- particularly when accompanied by unexplained bleeding- should prompt haematological evaluation. A multidisciplinary approach is critical for accurate diagnosis and improved outcomes in this patient population.

Giant plunging sublingual dermoid cysts with cervical extension: a case series

Tejaswi Gupta — 2026-09-25

Plunging sublingual dermoid cysts with cervical extension are rare developmental lesions that may present as combined intraoral and neck swellings and can pose diagnostic and surgical challenges. We present a case series of five patients with giant plunging sublingual dermoid cysts. The patients, aged 14-50 years, presented with long-standing, painless swellings associated with dysphagia and speech difficulty. Clinical examination revealed floor-of-mouth and cervical swellings, while imaging demonstrated well-defined cystic lesions occupying the sublingual space and extending into the cervical region, with posterior displacement of the tongue. Fine-needle aspiration cytology suggested dermoid or epidermoid cysts. All four patients underwent complete surgical excision through a transcervical approach. Histopathological examination confirmed the diagnosis of dermoid cyst in all cases. Postoperative recovery was uneventful, and no recurrence was observed during the available follow-up period. Giant plunging sublingual dermoid cysts should be considered in the differential diagnosis of cystic swellings of the floor of the mouth with cervical extension. Appropriate imaging is valuable for establishing the extent of the lesion and planning surgery, while complete surgical excision provides favorable clinical outcomes.