International Journal of Otorhinolaryngology and Head and Neck Surgery

Cartilage dorsum augmentation with composite soft-tissue coverage in thick-skinned rhinoplasty

Wed, 17 Dec 2025 00:00:00 +0530

Background: Thick-skinned noses often exhibit a combination of diminished dorsal height, reduced structural definition, inadequate radix projection, and a short overall nasal length. The dense soft-tissue envelope conceals underlying cartilaginous detail and frequently restricts refinement, especially in cases requiring dorsal augmentation. Achieving a smooth, natural dorsal contour in these patients can be difficult due to variability in envelope thickness and the tendency for cartilage edges to become visible beneath the skin. The objective was to evaluate the functional and aesthetic outcomes of dorsal augmentation using autologous cartilage combined with selective use of the native nasal composite soft-tissue layer as dorsal coverage.

Methods: Eighty-two patients with thick-skinned nasal anatomy underwent autologous cartilage dorsal augmentation with composite soft-tissue coverage. The composite layer was harvested as a single continuous sheet from the tip region. It was applied over layered or structured cartilage grafts to enhance dorsal contour smoothness and reduce graft visibility. Outcomes were assessed through long-term clinical examination, standardized photographic analysis, and validated patient-reported outcome measures including rhinoplasty outcomes evaluation (ROE) and Nasal Obstruction Symptom Evaluation (NOSE) scores.

Results: Dorsal contour smoothness, aesthetic-line continuity, and tip definition improved in all patients. No cases of infection, graft visibility, graft displacement, or vascular compromise were observed. Mild transient supratip edema occurred in 11% of patients and resolved with conservative management. ROE scores increased significantly after surgery, and NOSE scores demonstrated meaningful functional improvement. Long-term follow-up demonstrated stable results.

Conclusions: This technique provides a reliable method for managing the unique challenges of thick-skinned, low dorsum, or short nose anatomy.

Preoperative neutrophil-to-lymphocyte ratio as a prognostic indicator in papillary thyroid carcinoma: a retrospective analysis of 123 patients

Mohamed K. Abdelaal, Emad Abdelhafez, Mohamed M. Debes — Wed, 10 Dec 2025 00:00:00 +0530

Background: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy with an excellent prognosis, yet a subset of patients exhibits aggressive disease. This study aimed to evaluate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in PTC patients at Benha University Hospital, Egypt.

Methods: A retrospective cohort study was conducted on 123 patients who underwent total thyroidectomy for PTC between January 2014 and December 2023. The preoperative NLR was calculated from complete blood counts. An optimal cut-off value was determined using receiver operating characteristic (ROC) curve analysis. Patients were stratified into low-NLR and high-NLR groups. Associations between NLR and clinicopathological parameters and recurrence-free survival (RFS) were analyzed.

Results: The optimal NLR cut-off was 2.4. The high-NLR group (NLR ≥2.4, n=48) demonstrated significantly higher rates of aggressive features compared to the low-NLR group (NLR<2.4, n=75), including larger tumor size (2.1±1.1 cm versus 1.5±0.7 cm, p=0.001), extrathyroidal extension (52.1% versus 20.0%, p<0.001), lymphovascular invasion (29.2% versus 10.7%, p=0.008), central lymph node metastasis (58.3% versus 26.7%, p<0.001), and advanced AJCC stage III/IV (47.9% versus 14.7%, p<0.001). Multivariate analysis confirmed high NLR as an independent predictor for extrathyroidal extension (OR: 3.41, 95% CI: 1.54-7.55, p=0.002) and lymph node metastasis (OR: 3.85, 95% CI: 1.75-8.48, p=0.001). Kaplan-Meier analysis revealed significantly worse 5-year RFS in the high-NLR group (83.1%) versus the low-NLR group (97.1%) (log-rank p<0.001).

Conclusions: A preoperative NLR≥2.4 is a strong, independent prognostic marker associated with aggressive tumor characteristics and significantly worse recurrence-free survival in PTC. Its integration into preoperative assessment can enhance risk stratification.

Evaluation of a gravity-driven automated nasal irrigation system compared with manual syringe irrigation: a randomized crossover trial

Mon, 05 Jan 2026 00:00:00 +0530

Background: Large-volume saline nasal irrigation is widely recommended for sinonasal hygiene, but device design and pressure control influence effectiveness and tolerability. A novel automated irrigation device (NasiCare) utilizes gravity-regulated flow to deliver consistent low-pressure irrigation and may improve user experience compared with manual syringe use. Objectives were to compare the effects of an automated nasal irrigation device versus manual syringe irrigation on mucociliary clearance (MCC), safety, and user satisfaction in healthy adults.

Methods: In this prospective, single-blind, randomized crossover trial, 40 healthy volunteers aged 18-60 years completed two intervention visits: automated NasiCare irrigation and manual syringe irrigation. MCC was assessed using saccharin transit time (STT) pre- and post-irrigation. Adverse effects were recorded using a standardized checklist, and user satisfaction was evaluated across four domains (0-10 visual analog scale).

Results: Baseline pre-irrigation STT did not differ significantly between devices (median 6.58 vs. 6.95 minutes; p=0.380). Both devices resulted in significant post-irrigation STT improvement (p<0.001 for each), with no difference in post-irrigation STT (median 4.76 vs. 4.91 minutes; p=1.000) or STT change (1.59 vs. 1.53 minutes; p=0.085). Adverse events were infrequent and similar between groups, although nasal pain or tightness occurred only with syringe irrigation. Satisfaction scores were significantly higher for NasiCare across all domains, including overall satisfaction (median 10.0 vs. 7.0; p<0.001).

Conclusions: Automated low-pressure nasal irrigation provides MCC benefits comparable to manual syringe irrigation while demonstrating superior user acceptability and similar safety. These findings support the automated device as a reliable and more user-friendly alternative for routine nasal irrigation.

Nasal floor mucosal thickness in chronic rhinosinusitis: a computed tomography-based case-control study

Fri, 23 Jan 2026 00:00:00 +0530

Background: Tissue remodelling is a hallmark of chronic rhinosinusitis (CRS), yet the nasal floor has received little attention as a potential site of structural change. This study aimed to explore whether radiographic evidence of nasal floor mucosal thickening is a distinctive feature of CRS and a potential endotype marker.

Methods: This case-control study included 80 patients with bilateral CRS who underwent endoscopic sinus surgery and 80 controls. Nasal floor mucosal thickness was measured at two points on coronal paranasal sinus computed tomography (CT): anteriorly, where the inferior turbinate inserts the maxilla, and posteriorly, at the nasolacrimal duct opening into the inferior meatus.

Results: Mean nasal floor mucosal thickness was significantly greater in CRS patients than in controls at both anterior (2.52±0.74 mm vs. 2.02±0.59 mm) and posterior (2.05±0.63 mm vs. 1.52±0.44 mm) sites (p<0.001). Within the CRS cohort, anterior mucosal thickness was significantly higher in eosinophilic CRS compared to non-eosinophilic CRS patients (p=0.006).

Conclusions: Increased nasal floor mucosal thickness is associated with CRS, particularly in the eosinophilic endotype. Given its simplicity and reproducibility, nasal floor thickness may support non-invasive endotype differentiation and aid in clinical decision-making. Further prospective studies are needed to validate its diagnostic and prognostic value.

Fossa incudis approach in cochlear implant surgery: safe and easy technique for facial nerve preservation during posterior tympanotomy

Abdussalam Mohamed Jahan, Mohamed Omar Zaggot — Fri, 23 Jan 2026 00:00:00 +0530

Background: Cochlear implant surgery became worldwide operation used to manage patients with severe to profound sensory neural hearing loss that were not benefit from hearing aids. Facial nerve (FN) injury during the surgery still the most complication that the surgeons think about it during doing posterior tympanotomy.

Methods: A retrospective study including 76 patients complaining of severe to profound SNHL, get implanted in Misrata Medical Center, Misrata city, Libya, in the period between January 2018 and April 2020, using our new technique: Fossa incudis approach (FIA), in which and after cortical mastoidectomy performed, exposure of tip of short process of incus which situated in fossa incudis was done to become guide and help us to enter middle ear safe.

Results: After 76 operations performed on 76 patients with different anatomical situations, we report 0% FN injury. The time of surgery was relatively shorter (90 minutes±10).

Conclusions: Our technique (FIA) is safe and easy to learn; it helps us to minimize the incidence of FN injury and decrease the time of operation.

A descriptive cross‑sectional study of type and severity of hearing loss among diabetic patients in a tertiary care center

Musarrat Feshan, Preetham Achoor Puthukudy, Karamthot Anurag Rathod — Mon, 05 Jan 2026 00:00:00 +0530

Background: Hearing impairment affects communication and quality of life globally. Diabetes mellitus (DM) is linked to sensorineural hearing loss (SNHL) through microangiopathy and neural degeneration. Despite this, audiological screening is not standard in diabetic care. This study assessed hearing loss type and severity among diabetic patients and explored associations with diabetes duration and glycemic control.

Methods: A descriptive cross-sectional study was conducted over 18 months at a tertiary care ENT center. 100 patients with type 2 DM and audiologically confirmed hearing loss were included. Patients with type 1 diabetes, chronic ear disease, or ototoxic drug history were excluded. Demographics, pure tone audiometry findings, and HbA1c levels were recorded. Statistical analysis using SPSS included the Mann-Whitney U test, Kruskal-Wallis test, chi-square test, and Spearman correlation (p<0.05 significant).

Results: The 61-70-year age group was most affected (49%), with a mean age of 67.1±8.7 years; 58% were male. Bilateral hearing loss occurred in 85%. SNHL predominated (81% right, 72% left), mostly moderate severity (42% right, 30% left). No significant associations existed between hearing loss severity and diabetes duration (p=0.752 right, p=0.368 left) or glycemic control (p=0.70 right, p=0.78 left). Tinnitus was recorded in 26%.

Conclusions: SNHL was common among diabetic patients, primarily bilateral and moderate. Despite no significant correlations with diabetes duration or glycemic control, its frequent occurrence in this cohort supports routine audiological screening for early detection and enhanced quality of life.

Adaptation and validation of the Hindi mini tinnitus questionnaire

Abhishek Semwal, Srabanti Khemka — Fri, 23 Jan 2026 00:00:00 +0530

Background: Tinnitus, the perception of sound without an external source, can significantly affect an individual’s psychological well-being. However, tools for assessing tinnitus-related distress in the Hindi-speaking adults remain limited. This study aimed to translate, culturally adapt, and validate the mini tinnitus questionnaire (Mini-TQ) into Hindi (MiniTQ-H).

Methods: The Hindi translation of the original Mini-TQ was conducted following standardized guidelines. The study included 60 individuals, comprising of two groups: normal hearing sensitivity with tinnitus (NWT) (n=30) and hearing impairment with tinnitus (HWT) (n=30). Psychometric evaluation of the Hindi MiniTQ was performed, including assessments of internal consistency, test-retest reliability, criterion validity, and concurrent validity. Sensitivity and specificity of the MiniTQ Hindi version were determined using receiver operating characteristic (ROC) curve analysis.

Results: The MiniTQ-H demonstrated excellent psychometric properties. Content validity was confirmed by expert panel consensus, criterion validity demonstrated very strong agreement and Cronbach’s alpha for internal consistency was 0.822, indicating good reliability. Test-retest reliability was high, with all items maintaining significant correlations over time. MiniTQ-H showed a strong concurrent validity with THI-H. ROC analysis yielded a cut-off score of 14.5 with high score of 24, demonstrating high diagnostic accuracy in identifying individuals with tinnitus-related distress.

Conclusions: The MiniTQ-H is a culturally and linguistically appropriate tool for assessing tinnitus-related distress in Hindi-speaking individuals aged 18 to 60 years. It provides a reliable and valid measure for clinical and research use in India.

Development of Hindi word identification in noise test for school aged children

Himadri Bhagat, Srabanti Khemka — Fri, 23 Jan 2026 00:00:00 +0530

Background: Word identification in noise is crucial for effective communication in everyday environments. For children, the ability to identify words in noisy conditions directly impacts language development, learning, and social interaction. This study aimed to develop and standardize Hindi word identification in noise test for children (HWINT-C) and evaluate its performance among school aged typically developing children across varying SNR and word length.

Methods: The study included forty two participants which were further subdivided into subgroup one consisting of 22 typically developing children aged 6-7.11 years (SGI) and 20 typically developing children aged 8-10 years in subgroup two (SGII). Development of Hindi word identification in noise test for children (HWINT-C) involved multi-step processes including selection of words, familiarity rating, and content validation, internal consistency and test-retest reliability. The test included bisyllabic and monosyllabic words recorded by a native Hindi female speaker presented in eight-talker babble at +5 dB and +7 dB SNR administered dioticallyat 65 dB SPL.

Results: The developed HWINT-C in this study demonstrated to have high internal consistency and test-retest reliability. Typically developing children in the older group (SGII) significantly outperformed the younger group (SGI), Additionally performance improved with increasing signal-to-noise ratio (SNR) in both SGI and SGII, but no significant differences were found across word lengths.

Conclusions: The HWINT-C test is a reliable and valid tool for assessing word-in-noise perception in children. Age-related trend was observed, where performance improved with age, Similar findings were observed with increase in SNR, emphasizing need of favorable conditions in younger population.

A study of correlation of pre-operative hearing status and intraoperative ossicular findings in mucosal chronic otitis media

Fri, 23 Jan 2026 00:00:00 +0530

Background: Mucosal chronic otitis media (COM) is a common cause of hearing loss due to tympanic membrane perforation and middle ear pathology. Preoperative audiometry helps assess hearing impairment, but it may not always correlate with intraoperative finding. This study was conducted to assess the correlation between pre-operative hearing status and intra-operative findings, particularly, in patients undergoing tympanoplasty.

Methods: This prospective study has been conducted in patients presenting with mucosal type of COM in Otorhinolaryngology- Head and Neck Department of GKGH, GAIMS, Bhuj from the period of June 2023 to September 2024. All patients with mucosal COM without any intracranial complications were included in the study. Pre-operative and post-operative pure tone audiometry (PTA) threshold and Intra-operative findings were recorded and analysed using Microsoft Excel sheets.

Results: A total of 111 patients with clinically diagnosed mucosal-type chronic otitis media were included. The mean age of patients was 33.66 years, with a female predominance (64.9% female, 35.1% male). The majority of patients (41%) were in the 21–30-year age group. Comparison of preoperative and 3-month postoperative pure-tone average (PTA) demonstrated a statistically significant improvement in hearing levels following surgery. Graft uptake was successful in 98.2% of patients at 3 months postoperatively, with only 1.8% showing residual perforation.

Conclusion: Pre-operative hearing assessment, particularly through PTA thresholds, serves as a valuable predictor of intra-operative ossicular chain status. Tympanoplasty is an effective surgical intervention, leading to significant hearing improvement in patients with mucosal CSOM. Early diagnosis and intervention are crucial in preventing further ossicular damage and optimizing surgical outcomes.

Factors affecting the outcome of patients undergoing endoscopic septoplasty: a prospective study

Fri, 23 Jan 2026 00:00:00 +0530

Background: A deviated nasal septum (DNS) refers to an abnormal displacement of the septum from the midline. Endoscopic septoplasty has gained popularity due to its minimally invasive nature and better visualization of the septal deformities. The nasal obstruction symptom evaluation (NOSE) score is a validated, patient-reported outcome measure used to assess the severity of nasal obstruction and the impact of surgical intervention.

Methods: A randomized prospective clinical study was conducted with total of 81 patients of either gender, aged between 17 to 60 years, diagnosed clinically and radio logically with deviated nasal septum and scheduled for endoscopic septoplasty surgery from April 2023 to October 2024. The patients were evaluated for NOSE score. After undergoing endoscopic septoplasty patients were followed up weekly for 2 weeks and then every 15 days till 1.5 months. Post-operatively after 6 weeks NOSE score was calculated and it was compared with the preoperative score.

Results: The study included total 81 patients aged 17 to 60 years, with the highest prevalence in the 21–30 age groups and has male predominance across ages. DNS to the right was the most common finding. A majority of patients showed significant symptom relief postoperatively, with 19 patients achieving complete resolution (no symptoms), 50 improved to mild, 12 to moderate category.

Conclusion: Factors including age, gender, persistence of symptom has no significant role in outcome of endoscopic septoplasty as most patient resulted in significant symptom relief. The NOSE score proved to be an effective tool for assessing nasal obstruction, demonstrating a significant reduction of mean postoperatively following endoscopic septoplasty.

Second branchial cleft cyst in adolescent: a case report

Thu, 04 Dec 2025 00:00:00 +0530

Branchial cleft cysts are congenital lateral neck masses which manifest in the adolescents or in adulthood. They arise from the remnants of the branchial apparatus of embryonic life. Cystic remnants present commonly in the adolescence. Second branchial cleft cysts are the most common form of the branchial anomalies and originate from the remnants of the cervical sinus of His and its duct during the differentiation of branchial apparatus. Purpose of the study was to report a case of second branchial cleft cyst in adolescent. Patient was presented with second branchial cleft cyst at the age of 20 years. Computed tomography of neck showed well-circumscribed cystic lesion with an internal solid component in the peri vertebral space extending to the left submandibular space at the level of lower cervical region, attached to left sternocleidomastoid muscle causing minimal displacement of left internal and external carotid arteries medially and left internal jugular vein laterally, suggesting branchial cleft cyst. Complete surgical excision of the cyst had been done. The histopathologic study revealed a squamous epithelium-lined cyst with lymphoid infiltration, consistent with branchial cleft cyst. The patient was discharged without any complications. Clinical manifestations combined with knowledge of the embryology and spatial anatomy of the head and neck provide clues for a correct diagnosis and appropriate management of branchial cleft cyst.

Child with intranasal meningoencephalocele within the middle turbinate: case report

Aldo Jose F. da Silva, Diego de Oliveira Lima — Fri, 23 Jan 2026 00:00:00 +0530

Cephalocele or encephalocele consists of the herniation of cranial contents through a bony defect in the skull. An occipital meningoencephalocele is the most common whereas an intranasal meningoencephalocele is a rare type of cephalocele. Here, we report a case of an intranasal meningoencephalocele within the middle turbinate. A 9-year-old male child was admitted to the emergency department due to epistaxis and difficulty breathing. Computed tomography (CT) and magentic resonance imaging (MRI) results revealed herniation of a voluminous, predominantly cystic lesion next to the cribriform plate, extending into the right middle conus. During endoscopic endonasal surgery, a bulging middle turbinate was visualized and the herniated sac was found to be inside the turbinate. The herniated sac, together with the middle turbinate, was resected. The patient presented good evolution, with no signs of cerebrospinal fluid fistula. Intranasal meningoencephalocele is rare. Usually, the herniation is between the middle turbinate and the nasal septum, unlike in this case, where it was within the middle turbinate itself. Clinical symptoms can vary and include nasal obstruction, anosmia, rhinorrhea, epistaxis and meningitis. Imaging studies (CT and MRI) help with differential diagnosis (polyps, nasal glioma, dermoid cyst, teratoma, mucocele) and surgical planning. Surgical treatment can be open or endoscopic, as in the case reported here. In children with nasal masses, especially when there are no signs of cerebrospinal fluid fistula, intranasal meningoencephalocele should be considered, thus avoiding puncture or biopsy.

Spindle cell squamous cell carcinoma of postcricoid region of hypopharynx: a case report of a rare tumour in uncommon location with atypical presenting complaint

Syed F. Ali, Marium Amjad, Atiqa, Rahim Dhanani, Zoonish Ashfaq, Basit Arif — Fri, 23 Jan 2026 00:00:00 +0530

Spindle cell carcinoma (SpCC) is an aggressive subtype of squamous cell carcinoma characterized by a biphasic pattern with both sarcomatous spindle cell and epithelial squamous cell components. It accounts for less than 3% of all head and neck cancers, with a male predominance, presenting in the 5th to 6th decades of life. The larynx is the most commonly affected site, with dysphagia being the most frequently presenting complaint. Hypopharyngeal involvement is uncommon, particularly in the postcricoid region. We present a 55-year-old male with a complaint of bilateral neck swellings without dysphagia. An exophytic growth on the postcricoid region of the hypopharynx was evident on laryngoscopy, and histopathology confirmed SpCC. A computed tomography (CT) scan showed necrotic cervical nodes, and chemotherapy was initiated for treatment.

An unusual case of maxillary sinus involvement by a malignant peripheral nerve sheath tumour

Fri, 05 Dec 2025 00:00:00 +0530

Malignant peripheral nerve sheath tumours (MPNSTs) are uncommon aggressive soft-tissue sarcomas, accounting for approximately 5–10% of all sarcomas. Their occurrence in the head and neck region is rare, and involvement of the paranasal sinuses, particularly the maxillary sinus is exceedingly uncommon. Here we report a case of a middle-aged patient who presented with pain and swelling over left cheek, hard palate and nasal obstruction since 3 months. Clinical examination revealed a spherical swelling of size 3×2 cm present over left cheek with indistinct borders, another spherical swelling of size 3×2 cm on left side of hard palate. Patient underwent multidisciplinary evaluation, leading to surgical resection. Histopathological examination proved as low grade malignant peripheral nerve sheath tumour with Immunohistochemistry positivity to Vimentin. Patient underwent adjuvant radiotherapy and post-treatment follow-up showed no evidence of recurrence. This case emphasizes the significance of a broad differential, thorough histopathologic assessment, and coordinated multidisciplinary care to optimize outcomes in such rare presentations. Limited cases in the literature make diagnosis and management particularly challenging.

Granular cell tumor of the larynx – an unusual cause of the common symptoms

Fri, 23 Jan 2026 00:00:00 +0530

Granular cell tumors (GCTs), or Abrikossoff’s tumors, are rare neoplasms of neural origin, likely derived from Schwann cells. They typically affect the head and neck region, most commonly the tongue. Laryngeal involvement is uncommon, comprising 6–10% of cases. While most GCTs are benign, 1–2% may undergo malignant transformation. A 55-year-old female presented with hoarseness of voice for six months. Videolaryngoscopy revealed a single, sessile, pale pinkish mass with a smooth surface on the posterior half of the right true vocal cord, extending upto the right two-thirds of the posterior commissure. Vocal cords were mobile bilaterally. Laryngeal microsurgery was performed under general anesthesia. The mass extended inferiorly into the vocal process of the arytenoid, which was also excised. Histopathological examination confirmed a granular cell tumor, showing characteristic features including pseudoepitheliomatous hyperplasia of the overlying epithelium. Though rare, laryngeal granular cell tumors should be considered in patients presenting with glottic lesions and voice changes. Their histologic appearance can mimic squamous cell carcinoma, posing a diagnostic challenge. Awareness of this entity among otolaryngologists and pathologists is crucial for accurate diagnosis and appropriate management.

Sphenopalatine artery rupture following posterior nasal nerve cryoablation: a rare but serious delayed complication

Iris Zhorov, Melissa Goldstein, Eric Carniol — Fri, 23 Jan 2026 00:00:00 +0530

Posterior nasal nerve (PNN) cryoablation is an emerging minimally invasive procedure for managing refractory chronic rhinitis. Although generally well-tolerated, complications can occur. This report presents the first documented case of sphenopalatine artery (SPA) rupture following PNN cryoablation, highlighting the need for vigilance in postoperative care. A 64-year-old female developed delayed epistaxis one month postoperatively, requiring emergent arterial ligation. This case underscores the importance of anatomical considerations, and the potential risks associated with this innovative treatment.

Endolymphatic sac tumor: a rare neoplasm of the vestibular system

Fri, 23 Jan 2026 00:00:00 +0530

Endolymphatic sac tumors (ELSTs) are rare neoplasms originating from the endolymphatic sac, often associated with von Hippel-Lindau (VHL) disease. These tumors typically present with progressive hearing loss, vertigo, and vestibular symptoms, often mimicking Meniere’s disease. This case report discusses a 68-year-old female with a six-month history of progressive hearing loss and vertigo. Imaging revealed an ELST, and the patient underwent surgical resection via the translabyrinthine approach due to compromised hearing. Postoperatively, the patient underwent radiotherapy due to residual unresected tumor, stuck to posterior fossa dura and lying close to the ICA. A review of current literature on the diagnosis, treatment, and management strategies for ELSTs is also discussed.

A rare recurrent case of lateral nasal wall schwannoma: mimicking sinonasal carcinoma

Fri, 23 Jan 2026 00:00:00 +0530

Schwannomas are rare, benign, and slow-growing tumors that originate from the Schwann cells of peripheral nerves. They exhibit no sex predilection and are often characterized by a variable and delayed clinical presentation. The definitive diagnosis is established through histopathological examination. In this report, we present a rare case of a schwannoma arising from the lateral wall of the nasal cavity in a 45-year-old male patient. The tumor was successfully excised via endoscopic nasal surgery, and there was no recurrence observed at six-month follow-up.

Endoscopic intervention in second branchial sinus in a 5-month old infant

Fri, 23 Jan 2026 00:00:00 +0530

Second branchial sinus anomalies are rare congenital paediatric maladies that arise during intrauterine embryogenesis. A unique case of second branchial arch sinus in a 5-month-old infant, where a minimally invasive transcervical endoscopic intervention was undertaken, is being reported. The presentation was with recurrent discharge from a punctum at the lower lateral aspect of the neck. Global literature on second branchial arch anomalies is reviewed with clinical presentation, imaging, diagnosis, and therapeutic modalities of this rare entity.

A modification of the Abbe Estlander flap for lip defect reconstruction near the angle of the mouth

Sonali D. Ghodasara, Grishma M. Sakariya, Meet Rojesara — Fri, 23 Jan 2026 00:00:00 +0530

Lips play an essential role in aesthetics and in vital functions such as nutrition and speech. The complex anatomy of the lips-comprising three distinct layers of skin, muscle, and mucosa-makes surgical management of this region a therapeutic challenge. Excision of malignant tumors is the most frequent cause of tissue loss. The abundant blood supply of the lips allows the use of flaps for reconstruction of large defects with minimal risk of necrosis. Squamous cell carcinoma is the most common malignancy affecting the lips, and the lower lip is most frequently involved. This study was conducted at the Department of Surgical Oncology, Saurashtra Cancer Care Research and Institute, Rajkot.

Postoperative doxycycline after endoscopic sinus surgery for chronic rhinosinusitis: systematic review with quantitative synthesis

Ali M. Alshdokhi, Mubarak A. Alshahrani, Shahd J. Alharbi — Mon, 15 Dec 2025 00:00:00 +0530

The antibiotics are commonly and frequently prescribed after endoscopic sinus surgery to treat chronic sinusitis, although their clinical benefit remains uncertain. One such antibiotic, doxycycline, has antimicrobial and anti-inflammatory properties, which improve postoperative recovery. However, recent reviews of infectious complications after endoscopic sinus surgery suggest the importance of antibiotic use, but routine postoperative antibiotic use remains controversial. The study aims to assess whether postoperative systemic doxycycline improves symptoms, endoscopic healing, complications, or microbiome recovery after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). A PRISMA 2020-oriented systematic review with quantitative synthesis was conducted. The randomized or quasi-randomized adult studies comparing postoperative doxycycline versus placebo/standard care. The searches were performed in MEDLINE (PubMed), Embase, CENTRAL, and Scopus. The results show that of the 247 records screened, two randomized, double-blind, controlled trials met the inclusion criteria. Both evaluated doxycycline (100 mg for 28 days versus placebo) compared to placebo after esophagoscopy in adults with chronic atrophic rhinitis (with or without nasal polyps). Endoscopy and microbiome findings showed no sustained benefit with doxycycline. Side effects were rare and similar between groups. The certainty of the evidence ranged from low to moderate for all outcomes. The authors concluded that the current randomized evidence does not support a symptomatic or endoscopic advantage of postoperative doxycycline after ESS for CRS. While generally safe, its routine use cannot be justified given low-certainty evidence and the importance of antibiotic stewardship. Larger, well-powered trials with standardized outcomes are needed to clarify its role.

Case review: hearing and balance loss in Creutzfeldt-Jakob disease

Fri, 23 Jan 2026 00:00:00 +0530

Creutzfeldt-Jakob disease (CJD) is a rare transmissible neurodegenerative disease caused by misfolded prion proteins leading to rapid mental deterioration and death. Misfolded prion proteins form insoluble aggregates that cause irreversible neurological damage. While typically presenting with symptoms such as cognitive decline and behavioral changes, atypical presentations of CJD include symptoms such as sensorineural hearing loss or balance loss. The goal of this study is to systematically characterize atypical presentations of CJD with hearing and balance loss following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed database was utilized to analyze all case reports from the years 1990 to 2024 using the keywords “Creutzfeldt-Jakob disease”, “hearing loss”, and “balance”. A total of 16 cases were retrieved, and 11 were included in the study. Among cases retrieved, we identified eight patients with hearing loss and three with balance loss. Of hearing loss patients, four (50%) were male and four (50%) were female. The average age was 63.75 years (SD=11.17 years). The most common symptoms that accompanied hearing loss were analyzed (N, %), and include gait disturbances (8, 100%), myoclonus (6, 75%), cognitive impairment (4, 50%), akinetic mutism (4, 50%), and vision disturbances (4, 50%). The tests utilized to diagnose CJD in patients with hearing loss included MRI (5, 63%), EEG (5, 63%), and 14-3-3 protein (4, 50%). These findings highlight the importance of recognizing hearing and balance loss as potential early symptoms of CJD to aid in earlier diagnosis and a better understanding of disease progression.

Anatomy of the vestibular aqueduct and its clinical importance: a review

Santosh Kumar Swain — Fri, 23 Jan 2026 00:00:00 +0530

The vestibular aqueduct (VA) is a bony channel that houses the endolymphatic duct, linking the inner ear to the endolymphatic sac located in the posterior cranial fossa. The VA plays a crucial role in the metabolism and pressure buffer of the inner ear, and its enlargement can result in hearing impairment and balance disorders. The human VA often shows anatomical variations and even imaging can be difficult to appreciate, so clinicians need more data on the normal anatomy of VA for better understanding of radiological evaluation of enlarged VA. Enlarged vestibular adequate syndrome (EVAS) is reported to be one of the commonest anomalies of the inner ear associated with sensorineural hearing loss, although the exact mechanism of such loss is unclear. The EVAS can cause progressive sensorineural hearing loss (SNHL), in addition to sudden SNHL, conductive hearing loss, and mixed hearing loss. Mutations in a gene called SLC26A4 (formerly known as the PDS gene) are the primary cause of EVA and hearing loss. EVAS can be isolated or associated with cochlear malformation such as incomplete partition. There are no established criteria for diagnosis of EVAS. With advancement in imaging techniques, this VA and its anomalies are gaining greater interest among clinicians in recent years. High resolution computed tomography (HRCT) of temporal bone or MRI are helpful for the diagnosis of EVAS, with comparison to the adjacent posterior semicircular canal.

The emerging role of artificial intelligence in ENT surgery

Fri, 23 Jan 2026 00:00:00 +0530

The field of otorhinolaryngology has undergone a dramatic transformation in the past few decades owing to advances in technology. Advances in endoscopic surgery, microsurgery, laser surgery, surgical navigation, robotic surgery, etc., have improved management of several diseases with increased safety and have resulted in optimal outcomes for patients. Artificial intelligence (AI) refers to the ability of machines to mimic human intelligence and solve tasks that require complex decision-making. Artificial intelligence (AI) has become possible owing to advances in the disciplines of computer science, mathematics, and engineering and involves technology that enables computers to carry out operations that need human intellect, such as discrimination of words and objects, visual perception, and decision-making. The use of computational methods that rely on collecting and processing data helps reduce human labour. The collaboration of such AI technology with a challenging field like ENT surgery is evolving in the present day and is bound to enhance clinical practice worldwide. This review analyses the emerging influence of AI in each and every sub-specialty of ENT practice and highlights the key points of how this merger can establish and benefit clinicians in the near future.

Emergency endoscopic sinus surgery in pediatric complicated sinusitis: case insights and current evidence

Fri, 23 Jan 2026 00:00:00 +0530

Rhinosinusitis is an inflammation of the lining membranes of the nose and sinuses. Complications of rhinosinusitis, such as orbital and intracranial sepsis, are common in pediatric patients, which can be life-threatening if diagnosis and treatment are delayed. In this case series, we illustrate the emergency indications of functional endoscopic sinus surgery (FESS) in complicated rhinosinusitis in children diagnosed and treated at a tertiary hospital in Saudi Arabia. Three different cases of complicated rhinosinusitis with intraorbital and intracranial extension, including orbital abscess, invasive fungal granulomatous sinusitis with orbital extension, and optic nerve and frontal empyema secondary to frontal sinusitis. All cases were managed by a combination of medical treatment in the form of intravenous (IV) antibiotics and an urgent surgical debridement through functional endoscopic sinus surgery FESS to clean the sinuses, orbit, and brain. Postoperative CT scans confirmed no intraoperative or postoperative complications in all cases. Despite the wide use of antibiotics, the serious complications of sinusitis in children still exist. The management of such cases is usually through a combination of medical and surgical treatments. FESS in the pediatric population is a direct, safe, and practical approach in dealing with the serious complication of pediatric sinusitis with low morbidity and excellent outcomes.

Exploring rare entities of sinonasal tumours from diagnosis to treatment: case series

D. Ekta Priyadarshini, Vaishnavi Shetty, S. Jayasandeep, Sathish Kumar S. — Fri, 23 Jan 2026 00:00:00 +0530

Tumours arising from the nose and paranasal sinuses are diverse in nature and some are rarely reported in literature. Sinonasal tumours, though rare, represent a clinical challenge due to their complex presentation. Herein this case series studies about three unique cases of sinonasal masses i.e. sinonasal myxoma, esthesioneuroblastoma, follicular lymphoid hyperplasia which presented at our institution and their management. These nasal masses, presented with similar clinical features like nasal obstructions or with epistaxis, were diagnosed through clinical examinations, imaging, and histopathology, and were managed accordingly. Due to the delayed time of presentation in different age groups with common clinical features, the chances of misdiagnosis at an early stage are common. This necessitates for an early intervention and a multidisciplinary approach to manage such rare cases.