International Journal of Otorhinolaryngology and Head and Neck Surgery

Cognitive biases in otolaryngology: a systematic narrative review

Davis Thomas Pulimoottil — 2025-09-24

Cognitive biases are systematic errors in thinking that significantly impact decision-making in surgery, including Otolaryngology. These biases contribute to misdiagnoses, inappropriate treatments and surgical errors, affecting patient outcomes. Despite growing recognition of cognitive biases in medicine, awareness and structured training in cognitive debiasing strategies remain limited. This narrative review systematically examines cognitive biases affecting surgical decision-making in Otolaryngology, categorizes their occurrence in different phases of surgical care and discusses mitigation strategies. A comprehensive literature search was conducted using multiple databases, including MEDLINE, Embase and Scopus, focusing on cognitive biases in surgical fields, particularly Otolaryngology. Studies that explored bias-related diagnostic errors, treatment decisions and mitigation strategies were included. Cognitive biases were classified based on their impact on the diagnostic workup, treatment phase and post-treatment follow-up. A total of 71 cognitive biases were identified as relevant to Otolaryngology. These biases were categorized according to their definitions, sources, examples in Otolaryngology and mitigation strategies. Targeted mitigation strategies, including structured decision-support tools, cognitive forcing strategies and multidisciplinary case discussions, were highlighted. Cognitive biases play a critical role in surgical decision-making in Otolaryngology, often leading to diagnostic and treatment errors. Increased awareness and implementation of cognitive debiasing strategies are essential to improving clinical reasoning and patient outcomes. Future research should focus on the effectiveness of structured interventions and the role of artificial intelligence in mitigating cognitive biases in surgery.

Revisited the conventional manoeuver of Hippocrates in method in temporal-mandible joint dislocation

Manish Munjal — 2025-09-24

The human temporo-mandibular joint a synovial joint is unique as it goes through a range of movements necessary for masticatory functions. Being strategically positioned between the mandible and the temporal bone, in dislocations of this joint the individual presents with a painful open mouth. Though preferred, manual reduction under local anaesthesia can be undertaken in acute dislocations. Various techniques have been advocated in global literature The oldest technique is the “Hippocratic maneuver”, that has stood the test of time. The three step procedure can be undertaken in the outpatient setup even under sedation and local anesthesia. Naval surgeon William Paul Crillon Barton, introduced the usage of bandages to hold the repositioned mandible. Lewisg modified the procedure by carrying out the three step procedure of Hippocrates in a sitting position.

Complications of cochlear implant surgery: a review

Santosh Kumar Swain — 2025-09-24

A safe and proven surgical technique for auditory rehabilitation in cases of severe to profound hearing loss is cochlear implantation. The purpose of the CI is to convert auditory information into electric stimulation and to stimulate the cochlear nerve. Cochlear implantation is currently a common surgical technique due to the rise of CI candidates in recent years. The associated complication rates remain high even with the advancements in cochlear implantation procedures. One of the main concerns during CI surgery is infection. Implant extrusion, implant sepsis, migration of electrode, flap related problems, meningitis, and persistent non-auditory stimulation are major complications of cochlear implantations. Major complications are less common compared to the minor complications. The minor complications of cochlear implantations include tympanic membrane perforation, ear canal fenestrations, transient facial nerve paresis, chorda tympani nerve (CTN) injury, vertigo, and tinnitus. Device failure is the cause of second surgery and reimplantation. The clinicians/otologists should be aware of the possible complications of CI surgery. This article reviews different types of minor and major complications associated with CI surgery.

Tracheostomy co-colonization in autoimmune disease: beyond empiric treatment

Aimi Athirah Binti Azmi Murad — 2025-09-12

We report an unusual case of mixed Proteus mirabilis and Candida glabrata colonization of a tracheostomy tube in a patient with rheumatoid arthritis and Sjögren syndrome. Despite the striking appearance of blackish deposits on the tube surface, the patient was asymptomatic and endoscopic evaluation revealed no local pathology. The patient’s comorbidities likely contributed to altered airway microbial ecology, favoring biofilm persistence. Understanding biofilm behavior and differentiating colonization from infection prevented unnecessary antimicrobial therapy. This case highlights the importance of correlating microbiological findings with clinical and endoscopic assessments to guide management in chronic tracheostomy patients.

Thymopharyngeal cyst in an adult: a case report

Hoang Bui-Nguyen — 2025-09-24

A rare case of a thymopharyngeal cyst is identified in a young woman from Rwanda, who presented with a centrally located neck mass. Thymopharyngeal cysts, remnants of embryological thymic tissue, are infrequent findings especially in adults, and their diagnosis requires high clinical suspicion. We review the clinical presentation, diagnostic workup, surgical management, and discuss the literature on this rare entity. Our case report emphasizes the importance of including thymopharyngeal cysts in the differential diagnosis of central neck masses.

An unusual presentation of Burkitt lymphoma as a neck mass in immunocompetent adult male: a case report

Jayapriya D. — 2025-09-24

Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma defined by MYC gene translocation. The World Health Organization (WHO) and International Consensus Classification (ICC) recognize BL and Burkitt leukemia as manifestations of the same disease and differentiate BL from other high-grade B-cell lymphomas. The three clinical types-endemic, sporadic, and immunodeficiency-related-show differing geographic distributions and presentations. We report and unusual presentation of BL presenting as a left sided neck mass in a immunocompetent adult male. This case highlights the aggressive nature of BL and the importance of early and accurate diagnosis of through imaging and biopsy.

In the shadows: nasopharyngeal tuberculosis as adenoid hypertrophy in adult

Dilpreet Bajwa — 2025-09-24

Nasopharyngeal tuberculosis is an uncommon presentation, often posing a diagnostic challenge due to its rarity and the non-specific nature of its symptoms, which can mimic other more common ENT conditions. Tuberculosis is a multi-systemic disease affecting almost any part of the body. Primary nasopharyngeal tuberculosis is described as an isolated infection of the nasopharynx in the absence of pulmonary or systemic disease. A 38-year-old female patient presented to ENT department with complaints of nasal obstruction, cough. On flexible fiberoptic nasal endoscopy, nasopharyngeal mass was seen occupying whole of the nasopharynx. The mass had irregular surface with few necrotic areas over the surface. Post op recovery was uneventful. Final histopathology report came out to be suggestive of granulomatous disease with caseous necrosis. Patient has been on regular follow for the same and she has been showing adequate recovery with the medications. Nasopharyngeal tuberculosis is an uncommon presentation, often posing a diagnostic challenge due to its rarity and the non-specific nature of its symptoms, which can mimic other more common ENT conditions. Given the complexity and rarity of this condition, a meticulous, multidisciplinary approach was essential for accurate diagnosis and effective management. The patient was promptly initiated on an Anti-Koch's Therapy (AKT) regimen following confirmation of the diagnosis through advanced imaging and histopathological analysis. Her consistent and marked improvement on AKT underscores the importance and efficacy of a collaborative treatment strategy in managing such rare and complex ENT cases.

An atypical case-spindle cell variant of embryonal rhabdomyosarcoma of mandible

Priyadharshini Mahendra Varman — 2025-09-24

Rhabdomyosarcoma (RMS) is an aggressive malignancy and commonest malignant soft tissue Sarcoma predominantly seen in children and young adults. This study presents a case of a spindle cell embryonal type RMS involving the mandible of a 17-year-young male with a localized disease who underwent a R0 resection with tumor free margins followed by adjuvant chemotherapy, now with recurrence and metastatic disease, currently on palliative therapy. This report emphasizes the significance of early diagnosis and accurate immunohistochemical analysis in achieving successful treatment outcomes for RMS.

Unusual presentation of Thornwaldt cyst in the elderly: a case report

Betty Mariam Jacob — 2025-09-24

Thornwaldt cyst is an uncommon developmental midline cystic lesion arising from the pharyngeal bursa. It is most frequently detected in younger patients incidentally during imaging or diagnostic nasal endoscopy (DNE), and may later in the course of the disease present with symptoms secondary to nasal obstruction. A 75-year-old male presented with symptoms of progressive persistent nasal obstruction since three years, that worsened over past four months. DNE and Contrast enhanced computed tomography (CECT) showed a large midline nasopharyngeal cystic mass fully occupying the choana, measuring ~3×2 cm. Patient underwent transnasal endoscopic coblation-assisted excision of cyst where cheesy material and thick mucoid cyst content was identified. Histopathology showed Cyst wall lined by respiratory epithelium with reactive lymphoid cells. Follow up at 1 week and 2 months showed good postoperative healing of nasopharynx with no evidence of recurrence. Although rarely seen at this age, Thornwaldt cyst can be considered as a potential diagnosis in elderly patients presenting with nasopharyngeal mass- like lesion. In our experience with this case transnasal endoscopic coblation- assisted excision is an effective method for removal of nasopharyngeal cyst like lesions by providing adequate visualisation and access, with coblation wand acting as a single tool for excision, content aspiration and hemostasis.

An incidental finding of untreated cleft palate in an adult

Soumick Ranjan Sahoo — 2025-09-24

Cleft palate is one of the rare congenital conditions seen in clinical settings. Such cases present with speech difficulties. The cases are usually managed by a multidisciplinary approach and surgical management is done to repair the defect. Early repair of defect helps in development of normal speech. Here in a case of untreated cleft palate in an adult male is reported who had refused surgical management of defect. The patient was counseled and asked to take advice from a facial plastic surgeon.

Post-aural epidermoid cyst: a case of diagnostic detour

Oviya P. — 2025-09-24

Epidermoid cysts are benign lesions arising from epidermal inclusions within the dermis. They are the most common cutaneous lesions occurring in the third and fourth decades of life. Although frequently seen in the head and neck region, post auricular localization with regional extension is rare. The most common presentation is a painless swelling; however, pain may occur in cases with complications such as cyst rupture, secondary inflammation, or infection. This case presented with recurrent history of painful swelling in the post aural region with extension into the supra aural and zygomatic area. After evaluating with USG and CT, incision and drainage was done. 2 weeks post procedure patient had reappearance of the swelling that prompted further evaluation. MRI showed a positive finding of T2 hyper intense homogenous lesion in post aural region with diffusion restriction and communication with the incision and drainage site. On surgical exploration cystic lesion in post aural region with a small track in the supra aural region seen. Complete removal with histopathological studies done showed the diagnosis of post aural epidermoid cyst. This case highlights the need of high suspicions index in cases with recurrence or atypical presentations. Radiological evaluation and histopathological examinations aids in concluding the diagnosis.

Aspergillus niger associated calcium oxalate otolith in the external auditory canal: an uncommon clinical presentation

G. V. S. Rao — 2025-09-24

Otolith formation in the external auditory canal (EAC) can result from fungal colonization, particularly by Aspergillus niger, which secretes oxalic acid leading to calcium oxalate crystal deposition. While this mechanism is recognized in other anatomical sites, its clinical presentation in the EAC requires careful diagnostic consideration. This report describes a unique case of unilateral EAC calcium oxalate stone associated with A. niger, occurring alongside contralateral keratosis obturans. A 40-year-old immunocompetent male presented with bilateral ear discharge, hearing loss, and canal fullness. Otoscopy revealed hard masses in both EACs. The right-sided mass was removed under microscopy; the left required surgical excision via a postauricular approach. Specimens underwent histopathological examination and microbial cultures. Histology confirmed keratosis obturans on the right and calcium oxalate deposits on the left. Fungal culture from the left ear identified A. niger. The patient was treated with oral antibiotics and topical clotrimazole. Follow-up over six months showed complete symptom resolution with no recurrence. Post-treatment audiometry confirmed normal hearing thresholds. This case highlights the need for high clinical suspicion of fungal-induced otoliths in patients with chronic EAC obstruction. Bilateral pathology may have differing etiologies, warranting independent evaluation. Targeted surgical removal and antifungal therapy based on histopathology and culture findings can ensure complete recovery and prevent recurrence.

A locally advanced squamous cell carcinoma of buccal mucosa with extreme skin involvement managed surgically: a case report

Dishant Chhabra — 2025-09-24

Squamous cell carcinoma (SCC) of the buccal mucosa represents a prevalent subtype of oral malignancy, particularly among individuals with habitual tobacco and betel nut use. In advanced stages, the disease may exhibit rapid progression with invasion into adjacent anatomical structures, complicating therapeutic management. We report a case involving a 66-year-old female, Mrs. XY who presented with a large, ulceroproliferative lesion on the left hemiface. The lesion originated as a minor mucosal lesion and was initially managed with alternative medicine, ultimately progressing to involve cutaneous, muscular, and bony structures. Cross-sectional imaging revealed extensive local invasion, and histopathological analysis confirmed a moderately differentiated keratinizing SCC. The patient underwent bite composite resection, right radical neck dissection left modified radical neck dissection, and immediate reconstruction with a pectoralis major myocutaneous (PMMC) flap along with anterolateral thigh flap. The pathological staging was pT4aN3b with evidence of perineural and lymphovascular invasion and extranodal extension. This case underscores the aggressive nature of untreated oral SCC and highlights the necessity of early diagnosis, timely oncologic intervention, and multidisciplinary management in improving patient outcomes.

Nasal neuroglial heterotropia: a rare mimicker of dermoid cyst: a case report

Jayapriya D. — 2025-09-24

We report an uncommon case of nasal neuroglial heterotopia (NGH, glioma) presenting as midline nasal mass. Review of literature, imaging challenged and surgical management options are discussed. Unlike the more common nasal dermoid, 20% of NGH have intracranial communication which can cause post-operative life-threatening complications like CSF leak and meningitis.

Antro-naso-choanal polyp (proposed name)/antrochoanal polyp (famous name): excision without recurrence by combined endoscopic approach

Khaled M. Mokbel Khalefa — 2025-09-08

The primary goal of treatment for antro-naso-choanal polyp must be in the form of complete removal with total cleaning of the maxillary sinus to prevent recurrence. This retrospective case series study with (Institutional Review Board cod is R.25.08.3334), included 20 patients with antro-naso-choanal polyps (ANCP) (the proposed name for the usual name of the antrochoanal polyp). Patients were 14 males and 6 females with ages ranged from18-40 years. Under general anesthesia all cases were operated by combined transnasal and sublabial endoscopic approach. There was any recurrence through the average 18 months of follow up period. It is concluded that combined transnasal and sublabial endoscopic excision of antro-naso-choanal polyp is the best approach for complete removal without recurrence.

Adult epiglottic laryngomalacia and its surgical management

Priyanka Schilling Amar — 2025-09-24

Floppy and elongated epiglottis in adults causing airway obstruction is a rare clinical condition which needs immediate surgical intervention. We present a case series of six patients who presented in the outpatient department with floppy epiglottis based on the history and clinical examination and laryngoscopic findings which were managed by endoscopic partial epiglottectomy using diathermy. Surgical outcomes were assessed on outpatient follow up for next six months which showed improvement in the quality of life. Hence, this novel technique of diathermy improved the symptoms in adult epiglottic laryngomalacia.

A simple cartilage sparing “Madhumani technique” of endoscopic septoplasty

C. Madhusudana Rao — 2025-09-24

Deviated nasal septum is commonest cause of nasal obstruction, noisy breathing, sinusitis, sleep disturbance, headache, etc. Endoscopic septoplasty gives better results and better relief to the patients than age old procedure like submucosal resection (SMR). In our study, a total of 317 patients who were undergoing septoplasty and turbinectomy were included over the period of 3 years. 143 patients were female and 174 patients were male. All presented with complaints of breathing difficulty and nasal block. All cases were done by following our protocol of pre-op and post op care. Patients were followed up with 4 post op visits over a period of 6 months. All patients had symptomatic relief by 2 weeks post operatively. No major complications were encountered per operative and post operative. Minor complications like asymptomatic adhesions seen in very few patients which were released during the follow up visit. None of the patient needed revision surgery. This paper describes the simple enoscopic septoplasty technique followed by us in our institute. With our experience we framed simple, easy protocol of cartilage sparing “madhumani technique’’ of endoscopic septoplasty which can be easily followed and good results can be achieved by using septal splints as necessary.

Effect of nasal balloon auto inflation on hearing outcomes in children with otitis media with effusion

Shrikrishna H. Basagoudanavar — 2025-09-24

Nasal balloon auto inflation is a non-invasive treatment method commonly used to manage otitis media with effusion (OME) in children. This review aimed to assess its effect on hearing outcomes. A total of 10 studies, including randomized controlled trials, and cohort studies were included. The results consistently showed modest improvements in hearing, particularly tympanometric normalization and decibel gains in pure tone audiometry. Approximately 50% of children receiving auto inflation achieved tympanometric normalization compared to 38% in control groups, with relative risks ranging from 1.36 to 2.67. Some studies reported 6–7dB improvements in pure tone average. Compliance rates were generally high, often above 80%, and adverse events were mild and infrequent. Secondary benefits included better middle ear pressure, reduced need for ventilation tubes, and improved quality of life. The intervention, most commonly performed with the Otovent device, was well-tolerated and feasible in primary care. This review supports the use of nasal balloon auto inflation as an effective and safe intervention for improving hearing outcomes in children with OME.

Epidemiological, clinical and histological profile of oral carcinomas at the Sylvanus Olympio University Hospital in Lome

Palakina P. Agoda — 2025-09-24

Background: Early detection of oral carcinomas is a crucial public health issue. The aim of this study was to describe the epidemiological, clinical and histopathological profile of carcinomas diagnosed in a referral healthcare facility in Lomé

Methods: A retrospective descriptive study was conducted over a period of 10 years, including the medical records of patients presenting with carcinoma of the oral cavity confirmed by anatomopathological examination. Clinical and histopathological socio-demographic parameters were collected and analysed using R software version 4.0.4.

Results: Forty-five (45) cases of carcinoma of the oral cavity were included, with an annual frequency of 4.5 cases. Males predominated with 68.9% of cases. The age group 55 and over was the most affected, with 71.2% of the sample. Alcohol was the most common risk factor (82.2%). The tongue was the preferred site of oral carcinomas with 55.5% and squamous cell carcinoma was the most common histological type.

Conclusions: The carcinoma of the oral cavity in Lomé are predominantly male, in relatively elderly patients with an alcohol-smoking past. While awaiting more in-depth studies on risk factors, raising awareness of the harmful effects of these factors will make it possible to deduce the incidence and morbidity of carcinomas in Togo.

The influence of reconstruction following hemiglossectomy on perioperative outcomes

Richa Nathan — 2025-09-24

Background: Hemiglossectomy can be required for oral cavity squamous cell carcinoma (OCSCC) resection but can result in functional and aesthetic deficits. Flap reconstruction is employed to restore form and function following hemiglossectomy but has procedure specific complications.

Methods: Our study is a retrospective cohort study analyzing perioperative outcomes in patients undergoing hemiglossectomy with and without reconstruction using the American College of Surgeons' national surgical quality improvement project (ACS-NSQIP) database. We identified 866 hemiglossectomy patients from 2008-2022, 233 of these patients underwent flap reconstruction. Modified Poisson regression was used to assess the effect of flap reconstruction on the risk of perioperative morbidity and mortality.

Results: Patients who received reconstruction were 1.74 times more likely (95% CI: (1.31, 2.3) p<0.001) to have perioperative complications (pneumonia, ventilator use >48 hours, urinary tract infection, myocardial infarction, surgical site infections) and longer length of stay (10.71 vs. 3.67 days, p<0.001) compared to those without. American Society of Anesthesiology score (ASA) and neck dissection were found to be independent predictors of morbidity. In addition, the need for operative interventions like tracheostomy and neck dissection was more prevalent in the reconstruction group. The association was similar when limited to those who had concurrent neck dissection.

Conclusions: Higher rates of complications associated with flap reconstruction among hemiglossectomy patients underscore the importance of careful consideration and surgical planning in flap reconstruction following hemiglossectomy. Understanding the relationship between perioperative risk and long-term functional outcomes will inform surgical decision making.

The effect of decreasing the frequency of dupilumab administration after the first year on the control of chronic rhinosinusitis

Saleh Alali — 2025-09-24

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) significantly impacts quality of life. Many studies have shown the effectiveness of dupilumab in controlling CRSwNP using bi-weekly protocol over the first year. However, the effect of spacing the dose beyond the first year remains unclear. This study aims to assess the efficacy of the increasing the interval of dupilumab administration in maintaining the effect achieved in the first year.

Methods: This prospective study includes CRSwNP patients receiving dupilumab for over a year who transitioned from a bi-weekly to a four-weekly regimen. Clinical response was assessed using nasal polyp size (NPS), sino-nasal outcome test-22 (SNOT-22), Lund-Mackay score (LMKS), serum immunoglobulin E (IgE) levels, and eosinophilic count at three time points: pre-treatment, during bi-weekly dosing, and after switching to four-weekly administration.

Results: A sustained clinical improvement was observed across all time points. NPS showed significant difference F (2, 30) =85.97, p<0.0001, generalized eta squared=0.73. similarly, SNOT-22 scores and LMKS exhibited significant differences F (1.33, 19.95) =58.55, p<0.0001, generalized eta squared =0.69 and F (1.29,19.4) =69.41, p<0.0001, generalized eta squared=0.59 respectively. IgE levels and eosinophilic count also showed significant variation F (2, 30) =101.5, p<0.0001, generalized eta squared=0.6 and F (2, 28) 9.37, p<0.0001, generalized eta squared=0.13.

Conclusion: Decreasing the frequency of administration of dupilumab after the first year is associated with a sustained disease control.

Presentation and characteristics of deep neck space abscesses: a retrospective study of 128 cases in a single institution

Shaden Al Riyami — 2025-08-29

Background: Despite the development of antibiotic therapy, deep neck space abscesses continue to be potentially life-threatening conditions because of possible airway compromise and other complications. The purpose of this study was to present incidence, clinical features, management and outcomes of deep neck space abscesses, in patients admitted to a tertiary care facility over a 3-year period.

Methods: Medical records of the patients diagnosed to have deep neck space abscesses in the Al Nahda Hospital from January 2009 to December 2011 were reviewed retrospectively. Data on demographic characteristics, clinical presentation, imaging modalities, treatment methods, microbiology, and outcomes were obtained.

Results: A total of 30 patients (17 females and 13 males) with age ranging from 5 months to 71 years (mean age: 28.0 years) were analyzed. Majority of them presented with neck swelling, fever and pain. The parapharyngeal space (24%) was the commonest anatomical location. The majority of patients (81%) underwent incision and drainage, those remaining (19%) received intravenous antibiotics only. Culture was positive in just 17% of cases and Staphylococcus aureus was the most common organism. No patient required airway intervention. Diabetes was the most common predisposing factor.

Conclusions: Early detection and treatment are essential to avoid sequelae related with deep neck space abscesses. Surgical drainage is still the cornerstone in treatment after abscesses formation. A larger, multicenter prospective study is desirable to shed further light on the correlation between risk factors, age and treatment results.

A study on hearing loss in population with diabetes mellitus and its correlation with HBA1C values among patients attending a tertiary care hospital in Chennai

Khadhar Farzi Hussain G. — 2025-08-14

Background: Individuals with diabetes have twice the incidence of hearing loss compared to non-diabetics, and those with prediabetes show a 30% higher rate of hearing loss. HbA1c serves as an essential marker of glycaemic control in diabetics and is useful in predicting the development of complications associated with diabetes mellitus. This study was undertaken to estimate the prevalence of sensorineural hearing loss (SNHL) in the diabetic population and to determine the association between HbA1c levels and the degree of hearing loss in these patients.

Methods: This hospital-based analytical cross-sectional study was conducted at ACS Medical College and Hospital. A total of 85 diabetic patients aged between 20 and 55 years were included. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 21.0. The chi-square test was applied to determine the correlation between study variables. A p-value of <0.05 was considered statistically significant.

Results: The majority of participants exhibited poor glycaemic control. Profound and severe SNHL was observed in 28.2% and 16.5% of participants, respectively. Increasing age, longer duration of diabetes, and poor glycaemic control were significantly associated with SNHL.

Conclusion: Poor glycaemic control is a significant risk factor for SNHL among diabetics. Routine audiometric screening and strict glycaemic control may help prevent or delay the onset of hearing loss in this population.

A clinical study on sudden sensorineural hearing loss in tertiary care setting

Rajesh Kumar — 2025-09-08

Background: Sudden sensorineural hearing loss (SSNHL) is defined as a hearing loss of ≥30 dB over at least three contiguous frequencies within 72 hours. Despite multiple theories, in most cases, no definitive cause is identified, making the condition idiopathic. Vascular, infectious, and autoimmune mechanisms are often implicated. Given the unpredictable nature of SSNHL and variability in recovery, understanding its etiology, symptomatology, and severity patterns is essential for clinical management.

Methods: A cross-sectional observational study was conducted on 77 patients at R.S.D.K.S. GMC and MRD Memorial Hospital. Patients underwent audiological, vestibular, hematological, and imaging assessments. Severity of hearing loss and symptom associations were evaluated.

Results: Most affected age group was 31–40 years (22.08%). Male predominance was evident (70.13%). The most frequent symptom was aural fullness (44.16%). Profound hearing loss was most common (37.66%). Major known causes included diabetes and hypertension (9.09% each), while 64.94% of cases remained idiopathic.

Conclusion: SSNHL predominantly affects middle-aged males and often presents with profound loss. Most cases are idiopathic. Early diagnosis and intervention are critical to improving outcomes.

The causes of pure conductive hearing loss in relation with age groups

Manal A. Hamood — 2025-09-24

Background: Pure conductive hearing loss might be detected at any age, that made verbal communication is a problem issue, as well as, educational and social implications, therefore, earlier diagnosis and treatment of this problem is essential, since it`s have impact on patient`s life quality. To assess the causes of pure conductive hearing loss in relation with the age group.

Methods: A prospective observational study, where 38 patients at Otolaryngology unit were selected after taking a precise history, full (Ear, Nose and Throat) clinical examination and tunning forks tests assessment, as well as, complete audiological tests, within 1-year following-up period.

Results: Mean age in children (5.5±3.41 SD) and in adolescents and adults (25.5±1,78 SD) and (53%) males and (47%) females. Main usual reason of pure conductive hearing loss, among children was otitis media with effusion in about (55.55%), with association to adenoid hypertrophy (89.76%), while in adolescents and adults was otosclerosis (35%). Most common otoscopic findings was tympanic membrane retraction (44.73%) and the commonest chief complain was earache (68.42%).

Conclusions: Most common cause of pure conductive hearing loss, in children was otitis media with effusion, with high associations between it and adenoid hypertrophy, while in adolescents and adults, it was otosclerosis.

Effect of autologous platelet rich plasma on recovery after tonsillectomy in adult patients: a randomized controlled study

Syeda Muskaan — 2025-09-24

Background: Tonsillectomy is performed more frequently in children than in adults but post-operative pain is more in adults and restricts food and water intake affecting daily activities and quality of life. Healing of fossa takes 14-21 days to complete resulting in morbidity till fossa is healed. Platelet rich plasma (PRP) is known for its healing and analgesic effects and has led to its application in various conditions. This arose curiosity regarding the efficacy of PRP in healing of mucosal wound, reducing pain after tonsillectomy in adults.

Methods: Patients above 18 years presenting with signs and symptoms of chronic tonsillitis were chosen. These patients underwent Tonsillectomy followed by topical application of PRP in a randomly selected test fossa. Patients were followed up for assessment of pain and healing of the tonsillar fossa till post-operative day 10 and the results were compared between test and control fossa in each patient.

Results: On post-operative day 10, no patient complained of moderate pain in the test side while there was moderate pain in 4 fossae in the control side limiting their daily activities, majority of test tonsillar fossae were in stage 4 and 5 of healing; whereas control fossae were still in stage 3. Further, the onset of healing of test fossae was quite early compared to control.

Conclusions: Autologous PRP being easily available and cost-effective procedure can be included in routine tonsillectomy procedure as a method to alleviate pain and promote early and accelerated healing of tonsillar fossa in adults.

Role of preoperative serum calcium levels in predicting postoperative transient hypocalcemia in patients undergoing hemithyroidectomy surgery

Kiran Mali — 2025-09-24

Background: There is increase in incidence of thyroid disease and thyroid surgery over the years, mostly affecting females. Hypocalcemia following thyroid surgery can be fatal and increases hospital stay and cost. Transient hypocalcemia in postoperative period following hemithyroidectomy is seldom seen and often overlooked. We studied the role of preoperative serum calcium levels in predicting the postoperative transient hypocalcemia in patients undergoing hemithyroidectomy.

Methods: This is a prospective study on patients undergoing hemithyroidectomy at tertiary care hospital from June 2022 to February 2023. The serum calcium levels were recorded preoperatively and in immediate postoperative period (within 24 hrs after surgery). The serum calcium level of 9-11 mg/dl was considered normal range and level below 9 mg/dl was considered as hypocalcemia.

Results: Gender distribution was 50 females (90.9%) and 5 males (9.09%) with mean age of 38.6 years. Out of 55 patients who underwent hemithyroidectomy, 15 patients had low serum calcium levels (<9 mg/dl) preoperatively. Out of these 15 patients, 10 patients (66.6%) developed postoperative transient hypocalcemia. None of the patients had symptoms of hypocalcemia in postoperative period.

Conclusions: The preoperative serum calcium levels can predict the postoperative transient hypocalcemia in patients undergoing hemithyroidectomy surgery. In two-thirds of patient who had serum calcium levels below 9 mg/dl preoperatively developed postoperative transient hypocalcemia. Further studies are required to know the cause of low serum calcium levels preoperatively and postoperative transient hypocalcemia in patients undergoing hemithyroidectomy surgery.

A study on neonatal hearing screening in a tribal based medical college using screening otoacoustic emissions

Rajesh Kumar Kundu — 2025-09-24

Background: Hearing screening is a universal procedure for early detection and prevention of hearing loss. The Oto-acoustic emission (OAE) is a very useful screening test to rule out abnormal cochlear outer hair cells functioning which is lead to hearing loss.

Methods: This prospective observational study was carried out among 600 neonates who were admitted to NICU and post-natal ward from April 2024 to September 2024. Only TEOAE (Transient evoked OAE) was considered for this study.

Results: In this study among 600 neonates, 58.33 (%) neonates were male and 41.66 (%) were females, 155 (25.83%) were normal (without risk factors) neonates and 445 (74.16%) were high risk neonates and finally 544 (90.66%) neonates passed the test after second screening.

Conclusions: Screening OAE is a very reliable, fast, noninvasive and cost-effective approach, particularly for neonates. we can easily rule out the early listening to loss with the aid of the use of the device screening OAEs.

A cross-sectional study to evaluate the correlation between blood group and split ear lobule

Parth V. Pomal — 2025-09-24

Background: Cleft or split in the ear lobe can be unilateral or bilateral and various factors affect the development of split ear like wearing heavy ear ring for prolonged period of time. It may have association with blood group.

Methods: The study was conducted in ENT department of a tertiary hospital of western Gujarat from July 2021 to April 2025. The 405 patients with split ear (unilateral/bilateral) were enrolled in study and blood group of all patients was assessed and tendency for split ear in particular blood group was evaluated. All patients underwent split ear lobe repair by simple suturing technique.

Results: Out of total 405 patients, 137 patients had O positive blood group and 10 patients had B negative blood group. Bilateral split ear (64.44%) was more common than unilateral (35.56%). Mean age of patient was 44.79 year with standard deviation of 15.61 year. When compared with general population, where B positive accounts for 32% and O positive for 29%, while in split ear O positive blood group was the most frequently affected (34%) followed by B positive (30%), thus it did not mirror population prevalence trends.

Conclusions: We did not find significant association between split ear and blood group. O positive blood group with highest number of split ears is likely due to random distribution.

Incidence of thyroid dysfunction post radiotherapy in head and neck cancer

M. K. Mili — 2025-09-24

Background: Globally, head and neck cancer rank sixth in terms of incidence with squamous cell carcinoma being the most common. In case of early-staged cancer (T1 or T2), it is treated with a single modality of treatment, such as radiation therapy or surgery. In locally advanced head and neck cancer, it is treated with radiotherapy with or without chemotherapy. Primary hypothyroidism is indicated to be in between 11-53%. Aim is to estimate the incidence of thyroid dysfunction post radiotherapy in head and neck cancer.

Methods: This is a prospective and observational study done in a tertiary care centre over a period of 1 year in 66 patients. Written and informed consent was taken, data was collected in a predesigned questionnaire and baseline blood tests was done prior, 3rd and 6th month post radiotherapy.

Results: The incidence of hypothyroidism in our study was 15.15% with maximum incidence was found in Ca larynx (29.16%) followed by Ca hypopharynx (22.22%). 15.5% hypothyroid patients were treated with concurrent radiotherapy whereas 12.5% were not.

Conclusions: Hypothyroidism incidence increases with time, where majority develop after 6 months post-radiotherapy. Age, sex and concurrent chemotherapy were not identified as relevant risk factors in our study. Smaller sample size, shorter time period and single centre based were the limitations of the study.

The first prick counts: evaluating head and neck masses with fine needle aspiration cytology

Shivam Singh — 2025-09-24

Background: Cervical swellings are common clinical presentations with causes ranging from benign inflammatory conditions to malignant neoplasms. Fine needle aspiration cytology (FNAC) is a safe, rapid, minimally invasive, and cost-effective first-line diagnostic tool for their evaluation. The objective was to study the spectrum of head and neck swellings and assess the diagnostic utility of FNAC.

Methods: This observational study was conducted at Government Medical College, Khandwa, from February 2024 to February 2025, and included 100 patients with palpable head and neck swellings. After informed consent, FNAC was performed under aseptic precautions. Smears were stained with Papanicolaou, Giemsa, and Hematoxylin and Eosin (H&E) stains and evaluated cytomorphologically.

Results: Among 100 patients, 61% were females and 39% males (ratio 1.56:1), with a mean age of 35.5 years. Inflammatory lesions constituted 43%, benign lesions 46%, and malignant lesions 11%. Lymph node swellings (35%) were most common, predominantly tuberculous lymphadenitis (17%). Thyroid lesions formed 21%, chiefly colloid goiter. Salivary gland lesions comprised 14%, with pleomorphic adenoma as the most frequent. Malignancies (11 cases) included metastatic squamous cell carcinoma, lymphoma, and papillary thyroid carcinoma.

Conclusions: FNAC is a reliable, rapid, and economical diagnostic modality for head and neck swellings. It provides high diagnostic accuracy in distinguishing inflammatory, benign, and malignant lesions, guiding appropriate management and reducing unnecessary surgical procedures, especially in resource-limited settings where tuberculosis is still prevalent.

A prospective single blinded study on comparison of efficacy of intranasal instillation and cotton pledget packing as nasal preparatory methods for diagnostic nasal endoscopy

Keerthana K. — 2025-08-14

Background: Nasal endoscopy requires nasal preparation with local anaesthetic-decongestant combination to reduce the discomfort experienced by the patient. An ideal delivery technique that would cause minimal discomfort to the patient but ensures a good field of vision during nasal endoscopy is essential. To compare the efficacy and safety of intranasal nasal drops instillation and cotton pledget packing as preparation methods for diagnostic nasal endoscopy.

Methods: The present study was a prospective single blinded experimental clinical study conducted at ACS Medical College and Hospital. The sample size included 48 patients who were then divided into 2 groups of 24 each. 5 ml of lignocaine-adrenaline mixture was used for nasal preparation for DNE in both Cotton Pledgets (CP) and intranasal instillation (NI) groups. Data was entered and analyzed. A p value of less than 0.05 was considered to be statistically significant.

Results: There was no significant difference in the overall pain/discomfort experienced by the patients in both the groups. The pre-endoscopic and post-endoscopic findings showed that there was no significant variation in the visualisation of the various intra nasal structures among both study groups.

Conclusions: Cotton Pledgets (CP) and intranasal nasal drops instillation (NI) preparations for endoscopy have significant merits and demerits, but in terms of discomfort and pain during procedure, nasal instillation was an effective method for preparation of patients for diagnostic nasal endoscopy. This method can be a vital resource especially during emergency situations and among patients who are anxious or sensitive to nasal packing.

Demographic and clinical spectrum of sinonasal masses in a tertiary care centre

Abhishek Kumar Gupta — 2025-09-12

Background: Sinonasal masses constitute a wide spectrum of pathologies, ranging from benign polyps to malignant tumors. Their clinical presentations and demographic distributions vary significantly across regions. This study evaluates the demographic profile, clinical spectrum, and preliminary histopathological correlation of sinonasal masses in patients presenting to a tertiary care center in central India

Methods: A prospective observational study was conducted over 24 months on 162 patients with clinical and radiological features of sinonasal masses. Data on age, gender, residence, socioeconomic status, symptoms, side of involvement, provisional diagnosis, and histopathology were analyzed.

Results: Most patients were aged 19–30 years (56.3%), with a male predominance (53.1%). Nasal obstruction was the most common symptom (88%), followed by anosmia (42%), headache (36%), rhinorrhea (33%), and epistaxis (13%). Rural residents accounted for 67.3% of cases. The majority were benign lesions, with Allergic polyps (40.1%) being most common. Unilateral presentation (59.2%) was significantly associated with neoplastic pathologies.

Conclusions: Sinonasal masses predominantly affect young rural adults. Clinical evaluation, supported by imaging and endoscopy, is vital for diagnosis. Public health efforts should emphasize early ENT screening and accessibility in rural populations.