International Journal of Otorhinolaryngology and Head and Neck Surgery

Effect of adenotonsillectomy on otitis media with effusion

Chinwe I. Ojimadu — 2025-07-25

Background: Otitis media with effusion (OME) is a common cause of childhood hearing loss. In children, it may co-exist with adenotonsillar enlargement. In such cases, adenotonsillectomy combined with myringotomy and tympanostomy tube insertion is the standard surgical treatment approach worldwide. This study however, investigated whether adenotonsillectomy alone can resolve OME in children with concurrent adenotonsillar disease, with implications for reducing surgical morbidity and healthcare expenditures.

Methods: This prospective pre-test-post-test study was conducted at the Department of Otolaryngology, National Hospital Abuja, Nigeria. Ninety-five children (aged 1-8 years) with adenotonsillar hypertrophy and preoperative tympanogram types B or C underwent adenotonsillectomy. Tympanometric evaluations were performed at baseline (2 weeks preoperatively) and 6 weeks postoperatively to assess changes in middle ear function.

Results: Pre-operative tympanometry identified OME in 166 ears. Post-operative tympanometry at 6 weeks demonstrated resolution of OME (type B or C to type A tympanogram) in 88 ears (53%, χ²=22.5, p=0.001) which was statistically significant. Among the remaining 78 ears, 41 (24.7%) showed no change, while 37 ears demonstrated changes to alternative tympanogram types, (B to C, C2 to C1, B/C to as), which was considered a partial improvement (resolving OME, but not complete resolution).

Conclusions: Findings from this study suggest that adenotonsillectomy alone may resolve otitis media with effusion (OME) in children with coexisting adenotonsillar hypertrophy, with significant improvements observed at a minimum follow-up of 6 weeks.

Survival outcomes of locoregionally advanced papillary thyroid carcinoma

Yazeed M. Qadadha — 2025-07-25

Background: PTC carries an overall excellent prognosis. Most patients with PTC have small and asymptomatic disease. This raises the question whether overall rates overestimate the survival of those with advanced disease. We use our institutional data to report disease-free and overall survival of patients with locoregionally advanced PTC.

Methods: A retrospective study of 92 patients who underwent a total thyroidectomy from 2002 to 2019 at a single institution. Features of locoregionally advanced disease were defined as extra thyroid extension, primary tumor size ≥4 cm, or cervical nodal involvement. These and additional clinical and histological features were analyzed for association with recurrence and disease-free survival.

Results: Twenty-six patients had recurrence of disease. Patients with ETE, nonspecific cervical nodal involvement, or tumor size ≥4 cm had no significant increase in recurrence (p=0.2554, 0.1886, 0.2278, respectively). Patients with nodal metastasis to lateral neck compartment had a significant increase in recurrence (p=0.0434). 5-year overall survival was 95%.

Conclusion: PTC has an excellent prognosis even in the presence of advanced locoregional disease. However, lateral neck nodal involvement is associated with higher rates of recurrence and may be an indicator for more aggressive management.

A comparative study of endoscopic endonasal dacrocystorhinostomy with and without prolene stenting

Ravibabu Polisetti — 2025-07-25

Background: Dacrocystorhinostomy is the standard treatment for nasolacrimal duct obstruction. Incision was given at the fronto-nasal process of maxilla and flap was elevated by endonasal approach. Lacrimal bone is removed with Kerrison”s punch, lacrimal sac was identified and clear fluid was released. Intubating the nasolacrimal system during dacryocystorhinostomy (DCR) could prevent osteotomy closure and scarring. Outcomes of endoscopic En DCR with and without prolene stenting.

Methods: All patients with NLD obstruction who have recurrent watering of eyes or dacryocystitis. The study included patients of either sex who had symptoms and signs suggestive of chronic dacryocystitis. It includes a total of 50 patients. There were 21 males and 29 females.

Results: Canalicular irrigation or sac syringing provides essential information about the location of obstruction. Post operatively lacrimal syringing is performed to confirm the patency of the nasolacrimal fistula by directly visualising the flow of saline from rhinostomy opening using nasal endoscopy. In group A syringing was patent in 92% and non patent in 8%. In group B patients syringing was patent in 88% and non patent in 12%.

Conclusions: In this study we compared endonasal DCR outcomes with and without stents in 50 cases of Chronic Dacryocystitis in which prolene was used as a stent in 50% of the randomly divided cases. Based on available data and from literature, we conclude that En DCR is safe and simple.

Universal newborn hearing screening program – success story or a burden: experience from a tertiary care centre in North India

Akshay Bhatnagar — 2025-07-25

Background: Aim of the study was to find out the prevalence of congenital hearing loss in a tertiary care hospital in North India under the Universal Neonatal Hearing Screening Program, with a specific focus on identifying the association between neonatal hearing loss and neonatal intensive care unit (NICU) admission, low birth weight, or advanced maternal age.

Methods: A prospective cohort study of all newborns in a tertiary care center over 1.5 years.

Results: A total of 2891 babies were born during the study period, of which 2693 underwent newborn hearing screening, of which 2.4% (n=7) were detected to have neonatal hearing loss. Among the neonates admitted to NICU (n=76), a total of 2.7% (n=2) were confirmed to have hearing loss. None of the babies with low birth weight or with a history of advanced maternal age (>35 years) were detected to have hearing loss.

Conclusions: Our study primarily dealt with evaluating the key outcomes of a universal hearing screening program utilizing distortion product otoacoustic emission (DPOAE) and brainstem evoked response audiometry (BERA). NICU admission was identified as a specific neonatal risk factor correlating to hearing impairment (2.7%), with minimal or no correlation between low birth weight and increased maternal age.

Day-night community noise level during COVID pandemic: a nationwide study

Joyanta Chandra Mandal — 2025-07-25

Background: Community noise, also known as environmental or residential noise, encompasses all noise sources except industrial noise. The primary sources of community noise include road, rail, and air traffic, public construction works, neighborhood noise, and even industrial noise. During the lockdown, there was a complete shutdown across India, affecting all public sectors, institutions, and offices. This led to a significant reduction in community noise levels and their adverse effects.

The aim was to measure day and night noise levels in various areas across India during the lockdown period and to compare these levels with available data from the pre-COVID era.

Methods: For this study, community noise levels at specific times of the day and night were considered. Environmental ambient noise was measured on each measurement day, over a span of 30 separate days. During the lockdown period, data was collected from the locality using the "noise meter" application on an Android mobile phone, either from the balcony or the rooftop of the house.

Results: This study showed that the noise levels were even considerably low than the permissible noise level criteria given by central pollution control board (CPCB). The day time noise levels measured during the lockdown in the various part of country ranged between 36.7 dB to 50.14 dB. And during the night time was in the range of 10 dB-47.44 dB which was considerably lower.

Conclusions: These noticeable changes in the noise levels have given a scope of managing the noise levels by proper ordering of the activities accustomed to cause noise pollution and noise induced hearing loss also.

A prospective cross-sectional study of prevalence of sensorineural hearing loss in patients with chronic otitis media

Mohan K. Mili — 2025-07-25

Background: Chronic otitis media (COM) accounts for one of the major causes of acquired hearing loss, especially in developing countries. The hearing loss is mostly conductive, but many cases show mixed hearing loss of varying degrees, suggesting involvement of the sensorineural component as well. This study aims to estimate the prevalence of sensorineural hearing loss (SNHL) in patients of chronic otitis media and assess the clinical factors playing a role in sensorineural hearing.

Methods: Prospective analysis of clinical and surgical data of 80 patients with COM was studied. The bone conduction thresholds measured in both normal and affected ears were compiled. Disease duration, presence of cholesteatoma and its association with degree of SNHL were evaluated.

Results: In this study, COM was more common in the younger age group with a female preponderance. Prevalence of SNHL in COM was found to be 31%, out of which 21% had squamosal and 10% had mucosal disease. Mean bone conduction thresholds were significantly higher in the affected ear compared to the normal ear (p<0.05). No significant difference was found concerning the duration of disease. Although the incidence of sensorineural hearing loss was more in patients with squamosal disease, the degree of hearing loss did not vary with the presence or absence of cholesteatoma.

Conclusions: COM can lead to significant sensorineural hearing loss, and prompt evaluation for better management and hearing outcomes.

Patient expectation and satisfaction in septorhinoplasty: evaluation of the outcome pre- and post-operatively

Fatema Al Yarubi — 2025-07-25

Background: Septorhinoplasty is a common procedure aimed at correcting nasal deformities that affect both functionality and aesthetics. Achieving high patient satisfaction is crucial, particularly when patient expectations are aligned with surgical outcomes.

Methods: This prospective study included 50 patients who underwent septorhinoplasty at Al Nahda Hospital from April 2016 to June 2018. The evaluation was performed using the rhinoplasty outcome evaluation (ROE) and nasal obstructive symptoms evaluation (NOSE) scales preoperatively and at 6 and 12 months postoperatively. Statistical analysis involved paired t-tests and chi-square tests.

Results: Significant improvements in nasal obstruction and overall patient satisfaction were observed. Preoperative NOSE scores indicated substantial nasal obstruction, which improved significantly postoperatively. Patient satisfaction, measured by the ROE scale, increased notably after surgery, with 88% of patients reporting high satisfaction.

Conclusions: Septorhinoplasty significantly enhances both functional and aesthetic outcomes, with high patient satisfaction achieved through effective preoperative assessment and realistic counseling.

Comparative analysis of nasal mucociliary clearance in healthy tobacco smokers and non-smokers in Abuja, Nigeria: implications for respiratory health

Ifeoma C. Edevbie — 2025-07-25

Background: Nasal mucociliary clearance (NMC) is a crucial airway defense mechanism. Tobacco smoke, with its noxious components, impairs NMC, predisposing individuals to sinonasal diseases. Limited research exists in sub-Saharan Africa, where environmental and genetic factors may further influence NMC. The primary objective of this study was to investigate the effect of tobacco smoking on nasal mucociliary clearance time (NMCT) in healthy adults in Abuja, Nigeria, comparing smokers to non-smokers.

Methods: A community-based, prospective cross-sectional study was conducted on adults aged 18-45 in Abuja, Nigeria. Participants completed questionnaires on smoking history, medical history and comorbidities. Anterior rhinoscopy was performed, followed by a saccharine transit time test to measure NMCT in minutes.

Results: Three hundred and four (304) participants were recruited, with 152 (50%) smokers (60 smoked both cigarette and shisha, 55 shisha only, 37 cigarette only) and 152 (50%) non-smokers. The mean age was 30.7±6.3 years (smokers: 30.2±6.7; non-smokers: 31.3±5.9). Smokers had a significantly prolonged mean NMCT (14.96±3.75 minutes) compared to non-smokers (8.25±2.02 minutes) (t=20.197, p<0.001). Significant differences were found between all smoking groups and the non-smoker group (cigarette only: 17.08±2.69 minutes; both: 16.45±2.95 minutes; shisha only: 11.91±2.47 minutes; control: 8.25±2.02 minutes) (F=246.152, p<0.001). There was no significant difference in NMCT between those smoking both cigarette and shisha and those smoking only cigarettes (p=0.603).

Conclusions: Tobacco smoking significantly prolongs Nasal Mucociliary Clearance Time (NMCT), with cigarette-only smokers exhibiting the longest NMCT, followed by combined cigarette and shisha smokers and then shisha-only smokers.

Acute epistaxis, paying the price to be beautiful: a case report

Khairullah Bin Anuar — 2025-07-25

In the modern days, to look beautiful and stay beautiful is a choice and aesthetic clinics are mushrooming with new methods in addressing the needs of clients. Thread lifting coated with hyaluronic is one of the office procedures for the broad and flat nose. We report a case of epistaxis following this procedure. A 34-year-old lady went to an aesthetic clinic for a nose thread lifting procedure. Following the fifth injection she suddenly developed acute epistaxis which did not arrest on conservative methods. On examination she was distressed, vitals signs were stable, anterior rhinoscopy showed blood clot in the right nasal cavity and following rigid nasoendoscopy and nasal suction, it showed a blue suture like material between the septum and middle turbinate. Following removal of the foreign body and nasal toilet the epistaxis resolved. The thread coated with hyaluronic or the foreign body had migrated and causing the epistaxis. Following removal of the foreign body the epistaxis resolved. The clinical history is important in eliciting the possible cause and rigid nasoendoscopy is essential to assess the nasal cavity and assist in the removal of the foreign body.

Cochlear implantation in Klippel Feil syndrome: pitfalls and outcomes

Stuti Chowdhary — 2025-06-05

Cochlear implantation surgery involves multidisciplinary teamwork aiming for electrode insertion, which is as atraumatic as possible with an optimal intracochlear electrode position. Congenital inner ear anomalies often co-exist with musculoskeletal anomalies in syndromic children and can challenge cochlear implant surgery. The authors present a case of Klippel-Feil syndrome with congenital torticollis with bilateral inner ear anomalies who underwent cochlear implantation with multiple intra-operative surgical challenges. Multidisciplinary cooperation between the anesthetists, auditory-verbal therapy team, and the developmental pediatrics team is essential for a good outcome.

Long-term stability and condylar status evaluation following distraction osteogenesis for severe mandibular retrognathia with mild obstructive sleep apnoea: a 10-year experience

Andrews N. Kumar — 2025-07-25

This case report highlights role of distraction osteogenesis (DO) in the treatment of severe mandibular retrognathia with mild obstructive sleep apnoea (OSA), highlighting its ability to address complex maxillofacial deformities while ensuring long-term stability and temporomandibular joint (TMJ) health. Severe mandibular retrognathia with mild OSA, causes functional and aesthetic concerns. DO chosen over conventional orthognathic surgery due to its ability to gradually lengthen the mandible and create new bone formation, thereby correcting mandibular size and improving function and aesthetics. Significant improvement in facial aesthetics, correction of skeletal base relations, optimization of dental occlusion, and reduction in OSA symptoms confirmed through post-treatment assessments including cephalometric analysis and polysomnography (PSG). Ten-year follow-up demonstrated excellent stability of treatment outcomes with sustained improvement in facial aesthetics and absence of OSA symptoms. Cone beam computed tomography (CBCT) imaging confirmed the long-term health and functionality of the TMJ complex.

Gastrointestinal stromal tumour of larynx: a case report

V. Bala Krishna — 2025-07-25

Gastrointestinal stromal tumour (GITs) are the most common mesenchymal tumours of GI tract and occur mostly in stomach, small intestine and rarely in omentum, mesentery, retroperitoneum. These tumours arise from interstitial cells of cajal due to mutations in KIT (CD117) or PDGFRA. GIST most commonly present in the stomach (60%) or small intestine (20 to 30%) and may rarely occur extra gastro intestinally like omentum, mesentery or retro peritoneum. The 30% of GIST are malignant and common metastatic sites are liver, mesentery and omentum, lung, lymph node, bone, pancreas, colon are less common metastatic sites. Ultrasound, magnetic resonance imaging (MRI), CT, PET CT, endoscopy, endoscopy guided fine needle aspiration (FNA) or core biopsy are used modalities for diagnosis. GISTs are diagnosed by immunohistochemical methods. Surgical resection (open/ laparoscopic/ combined laparoscopic-endoscopic) is the main curative treatment. Most recurrences occurred within first 5yrs and a close follow up is required for early detection of relapses. Imatinib mesylate showed better response in advanced cases and recurrent cases. So far, there has been one publication found regarding gastointestinal stromal tumours occurring in vocal cords and one literature GIST of rectum with larynx metastasis. This current case report is regarding GIST occurring in vocal cords and its management. Further studies need to be conducted for better management options and to know the prognosis in such cases.

The precedence points of nasal herpes simplex: a case report

Ishita — 2025-07-25

There are very few documented occurrences of nasal herpes, a kind of facial herpes, in the literature. It is an uncommon appearance. This case report describes a patient who developed a herpes simplex lesion over the tip, alar lobule, and dorsum of the nose. Because of the unusual presentation and rarity of the condition, the patient was initially treated with oral anti-bacterial therapy. However, after the patient's symptoms did not improve, the patient was treated with the appropriate antiviral medications, and the lesion completely disappeared. The example illustrates an uncommon location for a common ailment with an unusual appearance.

Petrified pinna in a porter: a case report

Prabhakar Ulaganathan — 2025-07-25

This case report examines a rare instance of acquired petrified ear, a condition characterized by calcification or ossification of the auricular cartilage, potentially attributable to chronic mechanical pressure in an occupational setting. The study details the clinical presentation and radiological findings of a 50-year-old market porter who routinely carried heavy loads on their left shoulder, resulting in persistent compression of the left ear. Physical examination revealed a rigid, thickened, and smaller left pinna compared to the right. The patient did not report any associated pain. The patient had no history of trauma or metabolic disorders. There was no hearing impairment. Imaging confirmed that the left pinna was calcified. This case suggests a strong link between chronic occupational mechanical strain and the development of petrified ear.

Unveiling the rarity: a laryngeal myxoma arising from the epiglottis

Jishna Vayalakath — 2025-07-25

Myxomas are benign mesenchymal neoplasms which are rare in the head and neck region. Here, we present a case of a myxoma arising from the epiglottis, an exceedingly rare location in the head and neck. Our patient presented with a solid lesion arising from the lingual surface of the epiglottis. Histopathological examination and immunohistochemistry confirmed the diagnosis of myxoma. A myxoma arising from the epiglottis has not been reported in the literature during the last three decades. Myxomas should be considered in the differential diagnosis of benign-looking lesions of the larynx. The slow-growing nature of the tumor often delays symptom onset and diagnosis. Although recurrence is rarely reported in laryngeal myxomas, close follow-up is recommended.

Odontogenic cyst in a 45-year-old female: a case of enucleation under general anaesthesia

Riya Thakral — 2025-07-25

In a 45-year-old female presented with a recurrent swelling in the right mandibular region, reporting a history of marsupialization for an odontogenic cyst 12 years prior, though no medical records were available. Clinical examination revealed a significant swelling in the right mandibular ramus, accompanied by mild tenderness, discomfort, pain, and intraoral pus discharge. Radiographic imaging, including X-ray and cone beam computed tomography (CBCT) scans, identified a well-defined, expansile, osteolytic lesion in the right mandibular ramus, consistent with a dentigerous cyst. Given the lesion's recurrence and the lack of prior treatment records, surgical enucleation under general anesthesia was performed. Histopathological analysis confirmed the diagnosis of a pus-filled odontogenic cyst. The patient's postoperative recovery was uneventful, and she was scheduled for regular follow-up to monitor for any further recurrence. This case underscores the importance of long-term follow-up in patients with odontogenic cysts and highlights the potential for recurrence even after initial treatment.

Primary diffuse large B-cell lymphoma of the nasal cavity: a rare aggressive entity

Amrutha Aravind — 2025-07-25

Lymphomas are heterogeneous malignancies that arise from the clonal proliferation of lymphoid cells at different stages of maturation. Non-Hodgkin’s lymphoma (NHL) often involves extranodal sites, such as the gastrointestinal tract, skin, bone, and brain. The most common subtype of NHL is diffuse large B-cell lymphoma (DLBCL), which has varied clinical and pathological findings depending on the primary site. DLBCL arising primarily from the nasal cavity is a rare and distinct entity, as it constitutes only 0.2-2% of all cases of NHL. It has a wide range of presentations from mild early-stage symptoms to severe forms in later stages. The symptoms are primarily due to the obstruction by the tumor mass. Caution should be given for early diagnosis and initiation of treatment, as it is an aggressive tumor and can extend rapidly to adjacent structures. Here, in this report, an unsuspected case of primary nasal cavity DLBCL in a 70-year-old male is described, demonstrating the unusual location of DLBCL and the significance of its accurate diagnosis and treatment.

Acute otitis media in pregnancy with unilateral lower motor neuron facial nerve palsy: a case report

Salman Khan — 2025-07-25

We report the case of a pregnant female of 32-years at 37-weeks of gestational period with four days history of left sided lower motor neuron (LMN) facial palsy with a recent history of bilateral ear pain. She is in her last trimester of pregnancy and expected for a normal vaginal delivery. She had no other ailments and had no history of similar facial palsy in past. The case was managed conservatively with good outcome. Following our experience and review of literature on the case, antibiotic therapy and corticosteroid therapy, with or without myringotomy were found to be the first-line of management. To our knowledge, this is a rare report of LMN facial palsy in association with acute otitis media (AOM) and pregnancy. Some factors involved for LMN palsy in this case could be: compression of horizontal part of facial nerve due to otitis media, increases incidence of Bell’s palsy in pregnancy.

Case study of sinonasal cavernous haemangioma manifesting as recurrent nose bleeds with a literature review

Balaji Shankarrao Mane — 2025-07-25

Cavernous hemangiomas are relatively uncommon, primarily found in adults, particularly women. These tumors frequently present with unilateral nosebleeds and nasal blockage. Furthermore, there are only a few recorded instances of cavernous hemangiomas originating from the maxillary sinus in medical literature. This case report has been written because of the rare occurrence of cavernous hemangioma in the paranasal sinus. We present a case of a cavernous haemangioma located in the right maxillary sinus of a 30-year-old male. During an anterior rhinoscopy, a large necrotic tumor was observed, which bled upon contact and obstructed the right nasal cavity. A preoperative endoscopic biopsy was conducted on the mass to eliminate the possibility of cancer, but the findings were inconclusive. A CT scan displayed a mass occupying the entire right maxillary sinus and extending into the right nasal cavity, as well as reaching the ethmoid sinuses and choana, without any evidence of bone damage or displacement of the nasal septum. The Intraoperative frozen-section pathology showed that the respiratory epithelium displayed considerable haemorrhage, necrosis, inflammation, and edema, as well as the growth of blood vessels of different sizes. For our patient, the minimally invasive transnasal endoscopic approach was successful with minimal bleeding. The tumor was completely excised, and during the one-year follow-up, the patient has not experienced any recurrence. However, the final biopsy of the lesion confirmed that it was a cavernous hemangioma.

The diagnostic surprise of solitary anaplastic myeloma of mandible: a rare case report

Bala Krishna Vaddepally — 2025-07-25

Myeloma predominantly affects the elderly who develop a monoclonal protein which is found in their blood and/or urine manifesting as anemia, osteolytic lesions, hypercalcemia, bone pains and renal compromise. Osteolytic lesions are seen in more than 30% of patients with multiple myeloma. However, primary affection of mandible manifest as solitary plasmacytoma of bone occurs in only 4.4% such cases making it a highly unaccustomed entity. The aim of this case report is to present the clinico-pathological profile and the immunohistochemical features of anaplastic myeloma that will be of immense utility in diagnosing its affection of oral cavity and mandible precisely.

Advances in microvascular head and neck reconstruction using free fibula and radial forearm free flap to reconstruct various orofacial defects: a mini review

Bader Fatani — 2025-07-25

This mini review explores the efficacy of the free fibular flap and radial forearm free flap in reconstructive surgery, particularly for mandibular and head and neck reconstructions. The free fibular flap is established as the gold standard for mandibular reconstruction, boasting a high success rate and benefits such as a long pedicle, flexible skin island, ample dense cortical bone and minimal donor site morbidity, alongside a flap survival rate of up to 95%. While preoperative virtual surgical planning can improve outcomes for complex defects, its high costs hinder widespread implementation. Conversely, the radial forearm free flap is recognized for its versatility in managing large and medium-sized defects, although it necessitates careful consideration of potential postoperative complications and associated morbidity. Ultimately, both techniques present distinct advantages and challenges, underscoring the necessity for individualized surgical strategies in patient care.

The physiological and pathophysiological aspects of the human cochlea: a review

Manish Munjal — 2025-07-25

The fluids of the membranous labyrinth are in a state of dynamic equilibrium with the intracranial cerebrospinal fluid. Mechanical shifts in the ear canal, middle and inner ear due to tympanic, ossicular, and basilar membrane displacements are likely to result in electrolyte alterations with the generation of nerve impulses. Sound wave, depending on its frequency, attains maximum amplitude at a particular site on the basilar membrane and stimulates that very segment. Higher frequencies are represented at the basal turn of the cochlea, and the progressively lower ones towards the apex. The disturbance in the milieu interior is consequent to auditory and vestibular impairments. Physiology of the cochlea is altered in varied conditions like hypertension, renal disease, syphilis, chronic suppurative otitis media, diabetes, and noise trauma. The unique physio-pathology of the membranous labyrinth shall be elaborated.

The human cochlea - anatomical aspect: a brief review

Manish Munjal — 2025-07-25

The inner ear or the labyrinth performs the function of hearing and balance. It consists of a bony and a membranous labyrinth. Bony labyrinth consists of three parts – the vestibule, cochlea and the semicircular canals. Membranous labyrinth consists of the cochlear duct, the utricle and saccule, the three semicircular ducts, and the endolymphatic duct and the sac. The membranous labyrinth contains fluids which are in a state of dynamic equilibrium with the intracranial cerebrospinal fluid. Basilar membrane displacements result in electrolyte alterations and thus generate nerve impulses. Scala media is filled with endolymph that can be distinguished by its ion composition that is much like an intracellular character with respect to its potassium content. Scala tympani and scala vestibuli are filled with perilymph containing an extracellular-like ion composition and communicate at the apex of the cochlea via the helicotrema. The fluid contained within the tunnel of Corti and Nuel's spaces within the sensory epithelium resembles composition of the perilymph. The disturbance in the milieu interior is consequent to auditory and vestibular impairments. The unique anatomy of the membranous labyrinth shall be elaborated.

Tinnitus and the diabetic individual: a review

Manish Munjal — 2025-07-25

Tinnitus infact is a sound that is heard inside the head and not having an external source of origin. It is an unwelcome sensation that irritates continuously and dubious modalities have been advocated for its management. In the diabetic there is a multi-system involvement, with a major brunt, on the neural pathways and receptors. In the audiological region, a vital component of the nervous system, there is a high likelihood of onset of tinnitus, in subjects with underlying type 2 diabetes mellitus (T2DM).

Tracheotomy decannulation in the pediatric age group: an enigma

Manish Munjal — 2025-07-25

Asclepiades was the pioneer of a successful pediatric tracheostomy which is the commonest surgery undertaken in the critically-ill child for prolonged airway, ventilatory support and bronchial toilet. Newborn/neonatal intensive care units globally consider tracheostomy as a priority in their protocols, in the pediatric individual who have a high probability of retaining the endotracheal tube for a long period. The removal of the tracheostomy tube is called decannulation. Reinsertion of the tracheostomy tube within 48-96 hours is labelled failed decannulation. Sensorium, ability to cough, laryngo-tracheal secretions, and blood gas levels are crucial parameters prior to decannulation. Granulomas in the supra-glottic and subglottic region lead to stenosis which is one of the common reasons for an unsuccessful outcome. Mortality is usually secondary to the underlying ailment and, not the tracheotomy itself.

Overlay and underlay tympanoplasty revisited: a review

Manish Munjal — 2025-07-25

Myringoplasty conventionally is the reconstitution of the perforated tympanic membrane with placement of the graft either on the external or internal side of the residual eardrum The first recorded attempt to close tympanic membrane perforation was by Banzer in 1640; with a pig’s bladder membrane stretched over an ivory tube. Paper patching, perforation margin cauterization, the overlay or underlay, skin, fascia, perichondrium, cartilage or dural grafting were the developments in the repair of the ear drum. The temporalis fascia is superior to other grafts as it has a better uptake because of a low basal metabolic rate and, minimal shrinkage due to its low elasticity. Lateralization or medialization are the likely issues respectively of either technique. The technique and its development historically have been elaborated upon

Eustachian tube functions, revisited: a review

Manish Munjal — 2025-07-25

Myringoplasty conventionally is the reconstitution of the perforated tympanic membrane. There is a state of equilibrium between nasopharyngeal, middle ear and the external ear, air pressures. Middle ear ventilation and drainage is undertaken by the eustachian tube, a partially collapsible and rigid pipe linking the nasopharynx with the middle ear. There are controversial views regarding the value of a preoperative assessment of the function of the eustachian tube. Historically active and passive procedures for evaluation of the tubal function are vital components of the otological test battery. Outpatient tests like the Valsalva may not necessitate acquisition of sophisticated armamentarium but sono-tubometry and tube-manometry do so and are a bit expensive. The variety of subjective and objective tests have been elaborated upon wrt a successful uptake of the graft in myringoplasty.

Management of supraglottic tumors using carbon dioxide laser

Kuauhyama Luna-Ortiz — 2025-07-25

Laryngeal cancer has a high mortality rate in Mexico and worldwide. Supraglottic cancer, in particular, accounts for many cases, and treatment varies based on the clinical stage of the disease, the medical center’s expertise, and the economic and human resources. A retrospective study was conducted between 2005 and 2023 on 14 patients with supraglottic squamous cell carcinoma. Most patients were male (85%), with an average age of 68.5 years, and the same percentage were smokers. Endoscopic carbon dioxide (CO₂) laser resections were performed either alone, with induction chemotherapy, or as a salvage method following chemotherapy and radiotherapy. Laryngeal preservation was achieved in 92% of cases, with only one patient requiring total laryngectomy due to recurrence. Follow-up showed promising results, as most patients remained free of active disease for several years. Although some experienced local and regional recurrences, endoscopic CO₂ laser surgery allowed for laryngeal preservation in many cases. Additionally, induction chemotherapy followed by endoscopic surgery also proved effective in advanced stages, yielding favorable oncological and functional outcomes. Endoscopic CO₂ laser surgery is a reliable option for preserving the larynx in supraglottic cancer, even in advanced stages. Its oncological outcomes are comparable to those reported in the literature, offering a high rate of organ preservation and favorable long-term functional outcomes.

Primary glottic malignant melanoma: a case series and literature review

Abdullah Aldaihani — 2025-07-25

Primary glottic malignant melanoma (PGMM) is an exceptionally rare malignancy, with fewer than 30 documented cases in existing literature. Unlike cutaneous melanomas, PGMM typically lacks well-defined risk factors and presents at an advanced stage due to its insidious growth pattern. This study presents a case series of PGMM, emphasizing clinical presentation, histopathological findings, management strategies, and outcomes. Additionally, a comparative literature review highlights the challenges in diagnosis, treatment, and prognosis. PGMM is an exceptionally rare malignancy. Unlike cutaneous melanomas, PGMM typically lacks well-defined risk factors and presents at an advanced stage due to its insidious growth pattern. This study presents a case series of PGMM, emphasizing clinical presentation, histopathological findings, management strategies, and outcomes. A comparative literature review further highlights the challenges in diagnosis, treatment, and prognosis.

Pleomorphic adenoma of the hard palate: a case series

Oinam Priyokumar Singh — 2025-07-25

Pleomorphic adenoma is a benign mixed tumour composed of epithelial and myoepithelial cells arranged with various morphological patterns, demarcated from surrounding tissues by a fibrous pseudo capsule. The most common intraoral site is the palatal area, approximately 73%. Diagnosis is based on the history, clinical examination, radiological and histopathological examination. It should be treated as it carries the risk of 6 % malignant transformation. Wide local excision with adequate margin is the treatment of choice. Incomplete excision leads to recurrence. Here, we present a case series of 4 patients diagnosed with pleomorphic adenoma of the hard palate treated with wide local excision followed up postoperatively for 3 months.

Management of juvenile ossifying fibroma: insights from three cases and a review of literature

Sahil Sharma — 2025-07-25

Juvenile ossifying fibroma (JOF) is a rare, benign fibro-osseous neoplasm exhibiting locally aggressive behaviour predominantly localized within the craniofacial bones. This distinct entity is distinguished from ossifying fibroma (OF) by its earlier age of onset and an increased propensity for recurrence. A comprehensive review of existing literature, supplemented by a case series, is presented to elucidate the clinical, radiological, and histopathological characteristics of JOF. Diagnostic challenges associated with JOF are often encountered due to its variable presentation and potential overlap with other fibro-osseous lesions. Treatment is by surgical resection, with a focus on obtaining total excision to reduce the chance of recurrence. Long-term follow-up is crucial for early detection of recurrence. This combined literature review and case series presentation aims to improve knowledge of JOF, enabling more accurate diagnosis and effective therapy.

Management strategies of epistaxis with different etiologies

Snehalatha C. — 2025-07-25

Epistaxis is generally divided into two types; the more common anterior nasal bleed and the less common profuse posterior nasal bleed. Anterior bleeds arise from the antero inferior part of the septum, known as little’s area, where a plexus of vessels will be present, known as Kiesselbach’s plexus. Posterior bleeds commonly arise from Woodruff’s plexus. We encountered four cases of epistaxis in the last one year. Out of four, three were males and one female. The etiology of these patients was like Glanzmann thrombasthenia (GT), pseudoaneurysm of sphenopalatine artery and hypertensive urgency. So, they were managed according to their etiology. For the better outcome, proper team work is needed from various specialties.