International Journal of Otorhinolaryngology and Head and Neck Surgery

Rare case of extra nasopharyngeal angiofibroma arising from tonsil-case report

Udhaya Sankaran Sankarapandian — 2023-09-05

Angiofibroma is a highly vascular tumour. It occurs in adolescent males mainly in nasopharynx. Due to aggressive local growth, skull base location and risk of profound haemorrhage, management is challenging. Angiofibromas have been sporadically described in extra nasopharyngeal locations. Presentation varies depending upon the location of origin. Here we present a case of 7 year old boy presenting with difficulty in breathing with lump in the throat for 3 years, which has progressively increased in 4 months period with recurrent chocking while sleeping. Initially he was diagnosed with polyp arising from the tonsil. Polyp along with tonsil excised completely. Histopathology confirmed extra nasopharyngeal angiofibroma (ENA). To the best of our knowledge, only 3 cases arising from tonsil had been reported in English literature.

Cervical schwannoma: diagnosis and treatment

Amol Sulakhe — 2023-09-27

Schwannomas are benign, encapsulated, slow-growing, tumours deriving from the peri neural cells located in the nerve sheath. They can arise from any cranial, peripheral or autonomic nerves, and show a predilection for the head and neck region. They may produce secondary symptoms like nasal obstruction, dysphagia, and hoarseness of voice depending upon the location of the tumour. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. Preoperative imaging or fine needle aspiration cytology may help to reveal diagnosis. The definitive diagnosis is made by histopathological examinations. A 28 years old female patient presented to the OPD with painless swelling on the left lateral side of the neck since 1 year. The swelling was mobile, non-tender, non-pulsatile firm in consistency measuring 4×3 cm with no bruit. MRI neck with contrast was done which revealed a moderately enhancing lesion of size 7×4×3 cm in the left carotid sheath. The tumour was approached by an anterior approach along the medial border of the sternocleidomastoid. Platysma and fascia were dissected followed by carotid sheath to reach the tumour. As the mass was seen arising from a branch of the ansa cervicalis, it had to be sacrificed.

Recurrence of follicular dendritic cell sarcoma in tonsils after 7 years: a rare case report

Sowmya S. — 2023-09-27

Dystrophic calcifications are pathological mineral precipitates which occur in degenerative or dead tissue, despite normal serum calcium and phosphate levels, mostly seen in subcutaneous tissues secondary to infection or trauma. Chronic inflammation of the tonsils may lead to the formation of calcifications called tonsilloliths. The prevalence amongst the population is 2% to 16%, in age groups ranging from 10 years to 77 years of age, with a male/female ratio of 1:1. These calcifications display radiopaque images that are single or multiple, round or irregular, unilateral or bilateral and are superimposed upon the mandibular ramus. Computed tomography (CT) can be the investigation of choice for definitive diagnosis. The treatment of tonsilloliths is dependent on the size and presence of symptoms. It’s preferable to remove a single, large tonsillolith, as they can cause recurrent episodes of tonsillitis. Usually manual compression, curettage or a simple incision to release the calcified body should suffice for the relief. In case of numerous tonsilloliths, an attempt to remove them individually is not a feasible approach. Hence, bilateral tonsillectomy is opted.

A rare whistling foreign body bronchus

Grace Budhiraja — 2023-09-27

A case of toy-whistle as foreign body (FB) initially presented in sub-glottic location and later on got transferred to right segmental bronchus after induction of anaesthesia, is discussed. The FB was removed by rigid bronchoscopy. This case is illustrative of the problem inherent in removal of FB from air passages in children. The relevant literature has been reviewed.

Eclipsed sunray in the tonsil: mystery unfolded

Saranya Thangavel — 2023-09-27

Actinomyces are saprophytic, filamentous branched bacteria, living as commensal organisms in the oral cavity. They become invasive when they gain access to the subcutaneous tissue, through a mucosal lesion. The common predisposing conditions are having dental caries, dental manipulations and maxillo facial trauma. Actinomycosis of the tonsil is usually related to obstructive tonsillar hypertrophy rather than recurrent tonsillitis. Since actinomyces is a normal inhabitant of the human body, it will be found in every anatomical site of the body. But tonsillar actinomycosis results from reduction of oxidation- reduction potential caused by pyogenic and anaerobic infections. Mucosal trauma plays a major role in the entry of the organisms. These organisms produce toxins and proteolytic enzymes to cause pathology within the tonsil. Dilated cystic spaces and neutrophilic infiltration are the unusual features highlighted in this report. Antibiotic therapy along with tonsillectomy is suggested as the preventive and curative treatment for tonsillar actinomycosis.

Tonsillar Schwannoma: a rare case report

Stuti Shukla — 2023-09-27

A Schwannoma is a benign, locally aggressive tumor that occurs due to the proliferation of Schwann cells of the nerve sheath. These tumors may involve any cranial nerve and hence are routinely missed on diagnosis. We report a rare case of a young adult female with unilateral tonsillar fossa mass which was excised by transoral approach, and histopathology reported to be a tonsillar schwannoma. Hence, it is necessary to be aware of these rare benign tumors as they can mimic a tonsillar hypertrophy.

Recurrence of follicular dendritic cell sarcoma in tonsils after 7 years: a rare case report

Pratiksha Pawar — 2023-09-27

Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal neoplasm. It arises from not only from lymph nodes but also from extra nodal tissues, either as acquired lymphoid tissue or as part of the organized constitutive lymphoid tissue. We here report this rare entity which developed again after 7 years post tonsillectomy in a 5-year old male patient. Patient underwent radical tonsillectomy and adjuvant treatment is awaited. Differential diagnosis includes large cell lymphoma, peripheral nerve sheath tumor, extracranial meningioma, malignant melanoma, metastatic carcinoma, ectopic thymoma, malignant fibrous histiocytoma, and interstitial reticulum cell sarcoma. Currently, the management of FDCS includes the therapeutic guidelines similar to that of high-grade soft tissue sarcomas that is complete surgical resection of the lesion with possibility of adjuvant radiotherapy and/or chemotherapy. The ideal combination of management of FDCS has yet to be defined.

Basal cell carcinoma of nose

Amol Sulakhe — 2023-09-27

Basal cell carcinoma (BCC) is the most common type of skin carcinoma. It is usually observed in older patients, especially in those frequently and intensively exposed to ultraviolet radiation during their lives. The most typical site is uncovered skin directly exposed to the sun. The lower eyelid is the most common site, other sites being head, face, neck and limbs. A standard surgical excision is considered a good treatment option for all BCCs arising on the face with 5 year recurrence rates of anything up to 10% providing adequate margins are taken. A 3 to 5 mm margin is recommended for standard surgical excision. Reconstruction can be done with the help of various flaps.

Preoperative continuous positive airway pressure use improves the hospital experience of children undergoing adenotonsillectomy for obstructive sleep apnea

Katrina Zaballa — 2023-09-27

Background: Objective of the study was to determine how the preoperative use of continuous positive airway pressure (CPAP) in children diagnosed with obstructive sleep apnea (OSA), and their compliance with the therapy, impact perioperative outcomes of adenotonsillectomy.

Methods: A retrospective chart review was conducted on patients diagnosed with OSA on polysomnography, who underwent adenotonsillectomy between 2011-2017. Comparisons were made between patients who were not prescribed CPAP (N-CPAP), prescribed CPAP but non-compliant (NC-CPAP), and those compliant with their CPAP prescription (C-CPAP) therapy. OSA severity was categorized by total apnea-hypopnea index into mild <5, moderate 5-10, and severe >10.

Results: A total of 55 of the 162 patients (34%) were recommended CPAP. For those recommended CPAP, 25 were NC-CPAP and 30 C-CPAP. Compared to N-CPAP, NC-CPAP had a 47% reduction in wait time to surgery (p=0.0008) but 59% increase in LOS (p=0.001), while C-CPAP had 24% reduction in wait time (p=0.12) but 34% increase in LOS (p=0.026). Risk for post-operative admission to pediatric intensive care unit (PICU) was highest in NC-CPAP (OR=12 CI 3-44) and increased in C-CPAP (OR=9 CI 2-33). Children with severe OSA had higher frequency of postoperative CPAP use, NC-CPAP 29% and C-CPAP 64% (p≤0.0001). However, use of CPAP did not prevent a requirement for post-operative oxygen.

Conclusions: Amongst children prescribed pre-operative CPAP, compliance with therapy had a positive impact on the patient hospital experience following adenotonsillectomy.

Lateral and crestal sinus lift complications: a retrospective comparative study

Biser B. Stoichkov — 2023-09-27

Background: To explore the relationship between the operative methods for sinus lifting and related intra-and postoperative complications.

Methods: 47 cases of sinus lift were traced, with 118 implants placed. 83 of them after lateral sinus lifting and 35 with a crestal approach. Presence of bone septum, thickness of the sinus membrane, bone density, and the height of residual bone were tracked out preoperatively, as prerequisites of complications during and after implant placement in the distal parts of the maxilla.

Results: In eight cases (17.02%), sinus membrane perforations occurred. The most common location of the tearing was close to the lower medial edge of the bone window. After fixing perforation, a total of 37 implants were placed under these conditions. In three of them (5.41%), poor osseointegration was found after six mounts. Statistically significant impact of the thickness of the sinus membrane in cases of membrane tearing was found.

Conclusions: Increasing the height of the available bone in the distal areas of the maxilla by elevating the maxillary sinus floor is a safe and predictable procedure. Both the crestal and lateral approaches have a high success rate. All possible complications during the operation need to be analyzed in advance, and when they occur, it is mandatory to fix them adequately. Therefore, a careful consideration of the local and systemic conditions affecting implant survival is essential for successful implant treatment.

Comparison of physics forceps to conventional forceps in simple dental extraction

Shanender Singh Sambyal — 2023-09-02

Background: In this study, Conventional forceps & Physics forceps were compared in simple dental extractions with respect to crown and root fracture of tooth during extraction, alveolar bone plate fracture, gingival laceration, requirement of sutures, duration of surgery, comparative pain evaluation through visual analogue scale and analgesic requirement in the first 24 hours post operatively.

Methods: This study was conducted at our centre where 200 patients requiring simple dental extractions were randomly divided into two groups, each having 100 patients. Extractions in one group were done using Conventional forceps and in other group were done using Physics forceps. All parameters were measured during surgery & questionnaires were given to all the patients to assess the pain perception & analgesic requirement postoperatively till 24 hours.

Results: The results of present study showed decreased incidence of crown and root fracture of tooth, alveolar bone plate fracture, gingival lacerations, requirement of sutures, lesser duration for extraction and lesser pain perception in Physics forceps group. No significant difference was found between two groups for analgesic intake.

Conclusions: Physics forceps group patients had superior results compared to patients in Conventional forceps group which may be attributed to lesser hard and soft tissue injuries and better pain control in Physics forceps group.

Our experience of cut throat injury at a tertiary care center during COVID-19 pandemic

Deepak K. Gupta — 2023-09-27

Background: Cut throat injury is a least commonly attempted method of suicide or homicide. Neck injury may be suicidal, homicidal or accidental depending upon the etiology. Hesitation mark around the wound is favor of suicidal attempt and without hesitation mark is a rare possibility of suicidal attempt.

Methods: This is a retrospective study carried out over period of one year, between April 2020 to March 2021, in a tertiary care center of north central India, during Covid-19 pandemic before the second wave.

Results: Total 37 cases were attended; incidence was more common in male than female (34:3). Most commonly involved age group was 21 to 30 years, most of the patients belonged to rural background and manual workers. Homicide was the most common cause of injury and mostly under the influence of alcohol.

Conclusions: Young males belonging to lower socioeconomic status and rural background were most common victims of cut throat injury in our study, homicide being the most common causative factor. Life of the patients can be saved with less morbidity and mortality by the means of good triage management and early intervention.

Functional and anatomical outcomes following cartilage myringoplasty

Nidhi S. Mohan — 2023-09-27

Background: Myringoplasty using cartilage graft is being popular in recent years because of its better graft uptake and optimal hearing outcome. Thickness plays an important role in achieving optimal hearing outcome and although studies have shown 0.5 mm thickness to give better hearing results, concrete studies are lacking.

Methods: A prospective study was conducted in the department of otorhinolaryngology at a tertiary-referral-hospital in North-Karnataka; India between January-December 2019, on 25 patients of chronic otitis media; mucosal inactive or quiescent with conductive hearing loss and intact ossicular chain who underwent cartilage myringoplasty using conchal cartilage of 0.5 mm thickness. Follow-up was done at 3, 4½ and 6 months postoperatively to assess graft uptake. Hearing assessment was performed at the end of 6 months postoperative period with pure-tone audiometry.

Results: The preoperative mean pure tone average was 33.64±9.42 dB which improved to 22.56±7.41 dB at 6 months. At 3 months and 4½ months, there were 21casess (84%) of complete graft uptake, 3 cases of partial graft uptake (12%) and one case of total graft rejection (4%). Whereas, at 6 months postoperative period complete graft uptake was seen in 22 cases (88%) with 1 case of total rejection (4%) and 2 cases of partial uptake (8%).

Conclusions: Cartilage myringoplasty using 0.5 mm thickness conchal cartilage offers good hearing outcome in addition to significant graft uptake. As the conchal cartilage can be easily harvested from the site of incision for the surgery it can be an important primary alternative to temporalis fascia.

A prospective study of clinicopathological profile and outcome of otomycosis in patients presenting to a tertiary care center

Preetham A. Puthukudy — 2023-09-27

Background: Otomycosis is reported all over the world and it accounts for 5 to 20 percent of all cases of infective otitis externa during rainy seasons. The article's main purpose was to study the predisposing factors, most common symptoms, different species of fungi involved, and the treatment outcome of otomycosis. A Chi-square test was used to analyze the association of various factors. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis.

Methods: In this prospective observational study, 100 patients with clinical evidence of otomycosis were evaluated and data regarding age, gender, risk factors, clinical appearance, fungal culture, and treatment modality received were taken. Response to treatment at the 1st follow-up (at 1 week), 2nd follow-up (at 2 weeks), and 3rd follow-up (at 3 weeks) were statistically analyzed.

Results: In our study we found the disease to be more common among the 51 to 60 years age group. Males were affected more than females. The most common occupation was housewife. The most common predisposing factor was ear picking and the symptom was otalgia followed by itching. The disease was predominantly unilateral. Aspergillus niger was found to be the most common organism. Clotrimazole was the effective drug for otomycosis and significant responses were seen at the end of the 3rd week of treatment.

Conclusions: Aspergillus niger was the most common organism causing otomycosis and responded well with clotrimazole ear drops.

A study of otoacoustic emission and brainstem evoked response audiometry as audiological assessment modalities for early detection of hearing loss in children

Akshay Marathe — 2023-09-27

Background: Aim of the research was to study the incidence of hearing loss in high risk children up to 5 years age and determine the common etiological factors associated with it.

Methods: Total 140 neonates falling under the norms of inclusion criteria and the children brought by parents with suspicion of having impaired hearing were subjected to thorough history taking and clinical examination followed by audiological examination in the form of otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA). Those showing REFER or FAIL were subjected to BERA. Results were documented accordingly and analysed for identifying the common risk factors and degree of hearing loss.

Results: Maximum number of subjects with hearing loss were in the age group of 25-36 months age. Most common risk factor found was Consanguinity and most common postnatal risk factor was found to be hyperbilirubinemia. When compared to BERA, sensitivity of DPOAE was 97.59%, and the specificity was 92.98%.

Conclusions: Universal hearing screening of neonates at birth in the form of DPOAE and followed by BERA can reduce the average age of diagnosis of hearing loss and therefore, can provide an opportunity to initiate an appropriate rehabilitative program.

A study on the utility of KOH mount and HPR in the diagnosis of post COVID mucormycosis

Anjalikrishna B. — 2023-09-27

Background: Mucormycosis is a deadly disease that mostly affects the immunocompromised. Steroid therapy following COVID-19 infection has led to an alarming rise in the rates of this rare infection. Key to management of this disease is early diagnosis. The most common modalities used for diagnosis are KOH mount and histopathological examination. In our study we compare the efficacy of these two diagnostic modalities.

Methods: Nasal endoscopy was done in all suspected cases of the disease. Nasal discharge, crusts were collected in a sterile manner and sent for KOH mount examination. Specimens collected following surgical debridement was sent for HPR examination. The results of both are compared.

Results: In our study, HPR was positive in 82.2% cases while KOH mount showed positive results in 43.5% cases only.

Conclusions: Histopathology helps in confirming the diagnosis of mucormycosis. It also helps to demonstrate tissue invasion and identification of species of fungus. But it is time consuming. KOH mount examination is rapid and inexpensive but the test shows high false negative values. Thus, KOH mount examination can be used as a screening tool while histopathological examination can be used as a confirmation test for post covid mucormycosis.