bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin D Deficiency in South Sharqiya in Oman and its Impact in ENT Patients- A Retrospective Study
Authors: Segana Hasan Abdul Cader , Nair Reghunandanan , Shah Fahim Ahmed
Published: August 2020

Introduction

Vitamin D deficiency has multitude of causes and can present with varying clinical manifestations. Studies show that it can lead on to recurrent respiratory infections, ear infections and deafness. Vitamin D also has immunomodulant action. Here we discuss the varying features concerning an Otolaryngologist in general as far as Vitamin D metabolism is concerned.

Materials and Methods

This retrospective study was performed on 800 patients 152 males and 648 females of different socioeconomic background at secondary level regional referral hospital under Ministry of Health in Sultanate of Oman. The patients attending the outpatient clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH) D] level in blood. The patients were evaluated with general history, blood samples of serum calcium, phosphate, alkaline phosphatase and serum vitamin D level were measured by the most standardized laboratory of the country.

Results

Out of 800 patients, 275 cases had Vitamin D levels below 20 ng/ml and 167 patients had values greater than 30 ng/ml in serum.81% patients with vitamin D deficiency were females.56.25% patients were between third and sixth decade. Otolaryngologic manifestations were acute and recurrent URTI (n=352) 44%. 7% of the patients presented with recurrent ear infection (otitis externa). The rest of them presented to a lesser extent with deafness, otosclerosis.

Discussion

Vitamin D deficiency has been reported worldwide as one of the commonest deficiency diseases. It can lead to autoimmune dysfunctions, Beta cell dysfunction in pancreas, Multiple sclerosis, recurrent chest infections and congestive cardiac failure. Studies have shown the involvement of cochlea with sensorineural hearing loss and otosclerosis.

Conclusion

Vitamin D deficiency has multi system implications as patients presenting with different signs and symptoms. Mass level screening and vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health. Adequate vitamin D supplementation and sensible sunlight exposure to reach optimal vitamin D status are among the front line factors of prophylaxis for spectrum of disorders.
Factors Responsible for the Diagnostic Delay in Oral Cancer Patients: A Hospital Based Sociodemographic Study in Kolkata
Authors: Bhattacharyya Pramitasri , Mukherjee Dwaipayan , Barman Snehasis , Dey Tushar Kanti , Biswas Jaydip
Published: August 2020

Introduction

Oral cancer is a challenging health problem globally. Delay in diagnosis is an important factor in determining the outcome of the disease. It is a major determinant of mortality and morbidity of oral cancer patients. Present observational study was conducted with the objective of finding the factors responsible for delay in diagnosis of oral cancer in patients.

Materials and Methods

Hospital based observational study where patient register was used as data source from 15th Nov, 2013-15th Jan, 2014.

Results

Among the causes for delay in reporting to hospital, financial constraint (84%) and illiteracy (56.5%) have been found to contribute the most. The risk of primary delay is 3.53 times more among illiterate in comparison with literate. Age, gender, stage of cancer, religion, caste, tobacco use and delayed referral from the first physician were the other factors found to be significant in relation to primary delay.

Discussion

Early diagnosis is a major factor for favorable outcome of a disease and several factors hinder early diagnosis. Some of these factors can be easily modified through Information, Education and Communication (IEC).

Conclusion

Some important factors that lead to delay are identified and some of them are preventable. So, IEC regarding cancer among general population will not only provide knowledge to them, but also will break myths regarding cancer and reduce the burden of disease. These identified predictors of delay may be used for designing an educational intervention program for patients with oral cancers.
Endoscopic Skull Base Surgery: Our Initial Experience
Authors: Chakraborty Rajarshi , Singh Mukesh Kumar , Ghosh Swapan Kumar , Kundu Indranath
Published: August 2020

Introduction

Patients with lesions of the skull base form a minor but very important subgroup of patients presenting to the ENT surgeon or are referred from other departments with complaints such as headache, nasal discharge and nasal obstruction. This study was done to study the clinical presentation of the patients with lesions of the skull base, assess intra operative findings and complications, and to document post operative clinical course and histopathological reports.

Materials and Methods

A prospective study was conducted on 10 patients with skull base lesions, who were operated on at our institution between August 2014 and August 2015. Patients with clinically and radiologically documented skull base lesions operated by endoscopic methods were included, while those operated on with open methods or those having involvement of the cavernous sinuses and the internal carotid arteries were excluded.

Results

All patients in the group were successfully operated on with no major intra operative or post operative complications encountered. Adequate tissue was obtained for biopsy with adequate sellar decompression and plugging of CSF leaks was done as required.

Conclusion

Endoscopic interventions for the skull base lesions can be safely performed in tertiary care set ups with minimal intra operative and post operative morbidity and have a better prognosis than other open procedures.
Collaural Fistula: A Case Report
Authors: Pal Kalyan , Chakraborty Dipanjan , Kundu Sohag , Mukhopadhyay Subrata
Published: August 2020

Introduction

Collaural fistula or cervico-aural fistula is rare and accounts for less than 8% of branchial cleft anomalies. Their rarity and diverse presentations have frequently led to misdiagnosis and inappropriate treatment.

Case Report

We report one such case of a 7 year old girl who presented to us with two discharging cutaneous openings on the left side; one in the floor of the left external auditory canal and another in the upper neck and lower face (infra-auricular region).

Discussion

Surgical exploration and excision is the definitive treatment of a collaural fistula. A sinus/ fistula opening into the external auditory canal, should be removed with skin and cartilage. If more than 30% of the circumference of the external auditory canal is denuded, split thickness skin grafting and stenting are recommended. The potential post-operative complications are facial nerve paralysis and recurrence of the lesion. Fistulogram is a useful diagnostic tool.
Comparative Study of Autologous Ossicular Graft versus Titanium Prosthesis (TORP & PORP) in Ossiculoplasty
Authors: Thamizharasan P , Ravi K
Published: August 2020

Introduction

This prospective cohort study aims to analyze and compare the outcomes of ossiculoplasty in terms of hearing results, intra and post operative course, using autograft incus and titanium middle ear prosthesis.

Materials and Methods

Patients with a history of chronic ear discharge and conductive deafness were included in the study. Out of 21 patients with ossicular chain defect included in the study, 10 patients underwent ossiculoplasty with autograft incus and 11 with titanium prosthesis. Pure tone audiogram was done after three months.

Result

In patients with incus ossiculoplasty, average Post operative PTA was 43.5 dB ± 7.934SD and Net gain in hearing was 10.7 decibels ± 15.478SD. In patients with titanium prosthesis ossiculoplasty, average Post operative PTA was 41.4 dB ± 4.789SD and Net gain in hearing was 16 decibels ± 11.981SD.

Discussion

Three patients underwent only Tympanoplasty post operative PTA was 42 ± 5.292 dB (incus- 39 dB, titanium- 48dB) and hearing gain was 13.33 ± 12.583 (incus-20dB, titanium-0dB). Five patients underwent intact canal wall with Tympanoplasty: Post operative PTA was 35 ± 3 dB (incus-35dB, titanium-30dB) and hearing gain was 23 ± 15.379 (incus-18.33dB, titanium-30dB). Thirteen patients underwent canal wall down procedure with Tympanoplasty: Post operative PTA was 45.67 ± 5.228 dB (incus-50.4dB, titanium-41.8dB) and hearing gain was 9.33 ± 12.309 (incus-2.4dB, titanium-14.285dB). Complications in the short period studied were nil in both groups.

Conclusion

Incus and titanium have equal postoperative hearing but in terms of hearing gain Titanium prosthesis gave a better hearing gain than incus.
The Incidence of Thyroid Cancer in England and Wales over A Ten-Year Period
Authors: Evans Louise Marie , Stechman Michael , Owens David
Published: August 2020

Introduction

The incidence of thyroid cancer has increased worldwide, whether a real or apparent increase is debated. Literature from the USA suggests greater diagnostic scrutiny, environmental and genetic factors may all play a part. This increase will result in a greater number of referrals for surgical assessment. This study examined the trend in incidence of thyroid cancer in England and Wales.

Materials and Methods

A retrospective study, using the HES database over the period 2000-2010. Data were extracted of all newly diagnosed thyroid cancers in England and Wales and the age at diagnosis. Data were examined for the change in incidence of thyroid cancer diagnosis dependent on the age group of the patient using the linear regression model.

Results

45411 patients were identified. In England the incidence of thyroid cancer rose from 5.7/100,000 of the population in 2000 to 9.9/100,000 in 2010 and in Wales it rose from 3.5/100,000 in 2000 to 7.5/100,000. There was a statistical increase (P≤0.02) (t-stat >2) in the diagnosis of thyroid cancers across all age groups with exception of the 0-14 age group (P>0.5). 

Conclusion

There has been a statistical increase in the incidence of thyroid cancer. This is likely to impact on hospitals and cancer service resources. An increase in surgical demand and the coinciding ageing population highlights the importance of further investigation into the etiology, use of imaging, patient demographics, histology and overall mortality of this patient group.
Hypothyroidism – An Underestimated Complication After Hemithyroidectomy: A Preliminary Study Report
Authors: Aggarwal Neeraj , Dutta Sirshak , Panja Tanaya , Dutta Mainak , Ghosh Sanjoy Kumar , Sinha Ramanuj
Published: August 2020

Introduction

Hypothyroidism is a significant but an under-appreciated complication of hemithyroidectomy. The focus of this study was to assess the incidence of hypothyroidism occurring after hemithyroidectomy, identify the risk factors and to suggest a possible follow-up guideline for diagnosis.

Materials and Methods

An institution based preliminary study was conducted in the Department of Otorhinolaryngology, in a tertiary care hospital, from August 2014 to December 2015 on 25 patients. The patients were regularly followed up in 1st month, 3rd month, 6thmonth, 9th month and 1 year period with the thyroid function test.

Results

Incidence of hypothyroidism occurring after hemithyroidectomy including transient and permanent cases is 32%. Increased age of presentation, longer duration of thyroid swelling, pre-operative serum TSH level >2.5 mIU/ml, lymphocytic infiltration in histopathology and right sided hemithyroidectomy were found to be the possible risk factors.

Conclusion

It is indicated from this preliminary report that there should be a serial thyroid function monitoring in every post-operative hemithyroidectomy patient, and special attention should be given to the risk group
Effect of Different Positions of the Head on Tympanometry Results: An Exploratory Study
Authors: Chatterjee Indranil , Hembram Rabi , Chatterjee Shahi Arpita , Sinha Ashok Kumar
Published: August 2020

Introduction

Tympanometry is an objective measure of middle ear function that has been an integral part of the audiological evaluation test battery, for nearly three decades. The parameters of the tympanogram obtained are influenced with many factors such as introduction of positive or negative air pressure, speed of recording tympanogram, etc. This study was aimed to explore the influence of head positioning on tympanometric findings in normal ears.

Materials and Methods

Thirty ears of fifteen normal hearing subjects (mean age 22.8 years) and five ears of subjects (mean age 23 years) with high negative middle ear pressure were selected for the study.Tympanometry was done in four postures: head erect, head bent forward (chin touching the chest), head in supine and head lateralized towards one side.

Results

Two different results were obtained. It was interesting to note that the results significantly changed when the tympanogram was recorded after ten minutes in different head positions compared to those taken immediately after changing the head position.

Discussion

The possible explanation for the effect of duration in different head positions on tympanogram is discussed.

Conclusion

No significant changes were observed on static compliance, middle ear pressure, ear canal volume and pressure gradient when the tympanogram were recorded immediately bringing head in the particular posture. When head was held in the changed position for ten minutes, significant reduction in the pressure gradient was observed. Further extensive studies may be required to document the relationship between head positioning and tympanometric results.
Comparative Study to Assess Clinical Efficacy of Leukotriene Receptor Antagonist and Antihistamines in the Treatment of Allergic Rhinitis
Authors: Kaur Gurpreet , Dhingra Rachna , Singh Manjinder
Published: August 2020

Introduction

Pharmacologic treatment  options for allergic rhinitis include intranasal corticosteroids, oral and topical antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics and leukotriene receptor antagonists. The present study was undertaken to compare the efficacy of leukotriene receptor antagonist and antihistamines in relieving nasal congestion/ obstruction symptom and itching /irritation in eyes.

Material and Methods

The study was conducted among 125 patients clinically diagnosed suffering from allergic rhinitis Patients were divided into 5 groups and were given oral treatment with oral antihistamines (chlorpheniramine maleate, levocetrizine, fexofenadine, desloratadine) and leukotriene receptor antagonist (montelukast) for a period of 6 weeks. The results were tabulated and analyzed by Chi-square and Kruskal-Wallis test with p value <0.05 as significant value.

Result

For relieving nasal obstruction, levocetrizine group showed maximum improvement at 2 weeks. However, at the end of 6 weeks montelukast group showed maximum relief followed by levocetrizine and desloratidine.  In relieving eye itching/irritation, montelukast and levocetirizine were equally effective. Fexofenadine and desloratadine were less effective in relieving nasal obstruction and eye itching/irritation followed by chlorpheniramine maleate,  which was least effective.

Conclusion

Allergic rhinitis affects the social and professional life of patient. Allergen avoidance should be the initial step in the management of allergic rhinitis. Montelukast and levocetirizine are more effective in relieving nasal obstruction and  eye itching/irritation compared to fexofenadine, desloratadine and chlorpheniramine maleate.
Aerobic and Anaerobic Bacterial Isolates on the Surface and Core of Tonsils from Patients with Chronic Tonsillitis
Authors: Khadilkar Meera Niranjan , Ankle Nitin , Harakuni Sheetal
Published: August 2020

Introduction

Controversy regarding treatment of tonsillitis based on throat culture report still persists. If surface culture is a determinant of bacteriology of the core, then rational therapy could be aimed at organisms cultured by surface swab.

Materials and Methods

A Cross-sectional study was conducted on 100 patients of chronic tonsillitis who underwent tonsillectomy. Tonsil surface and core swabs were studied for aerobic and anaerobic growth.

Result

Eighty seven percent patients had aerobic growth on tonsil surface and ninety percent in tonsil core. Staphylococcus aureus was the commonest aerobic bacteria isolated. Anaerobic growth was present in 47% patients on tonsil surface, and 48% in core. Porphyromonas sp. was the commonest anaerobic bacterium isolated.

Discussion

There was no statistically significant difference between aerobic and anaerobic bacteria found in tonsil surface and core. 

Conclusion

Throat swabs adequately represent core pathogen, and are dependable in detecting bacteriology of chronic tonsillitis.
Evaluation of Results of Cartilage Augmentation in Type III Tympanoplasty
Authors: Pathak Netra Aniruddha , Rokade Vidya Vasant
Published: August 2020

Introduction

In conventional Type III tympanoplasty, post operative air-bone gap (ABG) is around 10-60dB. This study aimed to assess the hearing results in patients undergoing canal wall down mastoidectomy with cartilage augmented type III tympanoplasty. 

Materials and Methods

Patients of 6-50 years of age with the diagnosis of Chronic Otitis Media (Squamous) with conductive or mixed hearing loss, requiring canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent cartilage augmentation were included in the study. Pure tone audiometry (PTA) was performed and evaluated. Post- operative hearing was assessed in terms of average air bone gap (ABG) and size of ABG closure.

 Results

The results concluded that mean of pre and post operative air bone gap were 37.5db and 29.7db respectively with net gain of 7.8db.These differences were significant. Also ABG closure was within 30 db in 28 cases (70%).

Discussion

The results of this study were compared with other reported series. The mechanical and acoustical aspects of canal wall down surgeries as also the probability of variation in results due to differences in surgical procedures and post-operative fibrosis have been mentioned.  

Conclusion

There was significant improvement in postoperative hearing after stapes head augmentation in type III tympanoplasty.
Does Anterior Tunnelling Really Help in Underlay Type I Tympanoplasty?
Authors: Kundu Sohag , Ghosh Bhaskar , Adhikary Bijan Kumar , Dutta Mainak
Published: August 2020

Introduction

Stabilizing the graft can be difficult with the conventional method of underlay tympanoplasty when the tympanic membrane perforation is subtotal, large or anteriorly placed with thin anterior rim. Tympanoplasty with anterior tunnelling has been tried to overcome this problem.

Materials and Methods

A prospective study over two-year period was carried out with follow up for three months on 59 patients under two groups- the underlay tympanoplasty with anterior tunnelling and the conventional tympanoplasty with anterior tucking for comparison in terms of pre-and post-operative anatomical correction and physiological improvements

Results

Follow up at 6 weeks and 12 weeks post operatively gives statistically comparable graft take up, hearing result and residual perforations.

Discussion

Among various techniques of dealing with these types of perforations, statistical comparability of the two groups brings in an acceptability to this simple but satisfying procedure of the underlay tympanoplasty with anterior tunnelling.

Conclusion

Underlay tympanoplasty technique (type-I) for subtotal, large or anteriorly placed perforations with thin anterior rim, can be managed by combining with anterior tunnelling which provides at least comparable results (if not more security against graft medialization) in respect of anatomical closure of perforations and hearing outcomes.
Hydatid Cyst of Tongue: A Diagnostic Challenge
Authors: Aggarwal Neeraj , Panja Tanaya , Biswas Khuku , Kar Titas
Published: August 2020

Introduction

Hydatid disease or human cystic echinococcosis is a parasitic zoonosis, endemic in the cattle and dog rearing region worldwide as well as in some parts of India.Cystic echinococcosis affects mostly the liver and lung (80%), but tongue is one of the very rare sites.

Case Report

A 10 year old boy had presented with an isolated cystic lesion in tongue, which was expelled spontaneously with no residual lesion. On detailed examination, no other site in the body was involved.

Discussion

Parasitic cyst of the tongue is rare entity. Microbiological and histopathological examination helped clinch the diagnosis Hydatid cyst should be considered as a differential diagnosis in isolated cystic lesion of tongue, especially in the risk group.
Sino-Nasal Outcome Test-22: Translation, Cross-cultural Adaptation, and Validation in Local Language
Authors: Yeolekar Aditya M , Rokade Vidya , Shinde Kiran , Pathak Netra , Qadri Haris , Kahane Kaustubh
Published: August 2020

Introduction

Quality of life questionnaires have been increasingly used in clinical studies to help estimate the magnitude of problem. Sino-Nasal Outcome Test -22 (SNOT-22) is considered to be a good tool to measure the severity of Sino-Nasal Diseases. As this test is in English, it may be difficult for the local population to express their symptoms correctly. Therefore we have translated and validated the SNOT- 22 test in local Indian language, Marathi.

Materials and Methods

An early Indian ( Marathi ) version of the SNOT 22 questionnaire was prepared. This was a prospective study,where forty patients with Sino-nasal Diseases confirmed on DNE & CT(PNS) filled the questionnaire. This was repeated after a period of 14 days to retest. For validation the questionnaire was also filled by healthy individuals.

Results

The mean SNOT-22 score ± SD was 50.17 ± 18.65 (range 10–93) in the initial test, and 49.61 ± 18.40 (range 21–91) in retest in the study group. Cronbach’s alpha was 0.835 and 0.837 at the initial and retest examination respectively, both values were suggesting a good internal consistency. The mean SNOT-22 score ± SD was 13 ± 11.68 in the control group and 49.61 ± 18.40 (range 21–91) in the sino-nasal disease group and proved by Mann- Whitney U test.

Conclusion

The Marathi SNOT-22 is a valid instrument to assess the symptomatology of patients of Sino-nasal Diseases in Maharashtra.
A Novel Technique of Using Sponge as Post-Operative Nasal Packing
Authors: Thomas Ike , Thekkethil Jathin Sam , Kapoor Ramesh Chandra , Thomas Tina , Thomas Pramod
Published: August 2020

Introduction

In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient.

Materials and Methods

This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously.

 

Result

The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge.

 

Conclusion

The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.
A Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty
Authors: U P Santosh , J Sridurga , D R Aravind
Published: August 2020

Introduction

            Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively.

            In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn.

Materials and Methods

Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected.

 Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed.

Result 

In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation.

Conclusion

            In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.
A Multi-Modality Surgical Management in Laryngeal Stenosis
Authors: Ansari Ashfaque , Thomas Annju
Published: August 2020

Introduction

Postintubation laryngo-tracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngo-tracheal stenosis secondary to long-term intubation/ tracheostomy with review of the literature.

Case Reports

In this retrospective study, we present 5 cases (23-year-old male, 13 year old male, 22 year old male, 19 year old male and 33 year old female) of post-intubation/tracheostomy laryngo-tracheal stenosis (glottic/subglottic) stenosis in the year 2016 to 2017. Each patient was managed differently. A patient with history of multiple subglottic stenosis dilations and stenting underwent open surgical subglottic stenosis resection and anastomosis, LASER assisted resection of stenosis with stenting was done in a patient with history of dilation, LASER assisted resection and dilation followed by Mitomycin C application was done in another patient with history of poisoning, plain endoscopic dilation was done in one patient with history of head injury and Kashima’s Cordotomy with release of interarytenoid adhesion by LASER was done in one patient.

Conclusion

Resection of stenotic segment by open surgical anastomosis and laser assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
A Peripheral Primitive Neuro-ectodermal Tumor (pPNET) of Larynx
Authors: Wadhera Raman , Sehrawat Usha , Hernot Sharad , Gahlawat Pawan Kumar , Jakhar Aman
Published: August 2020

Introduction

Primitive neuroectodermal tumors (PNETs) are malignant tumors comprised of small round cells of neuro-ectodermal origin that affect soft tissue and bone. Though the occurrence of pPNETs in the head and neck region is rare, these are aggressive malignant tumors, and long-term survival rates following diagnosis remain poor.

Case Report

In the present case, a tumour was located in larynx (as globular/cystic mass of epiglottis) of the patient and was diagnosed as pPNET. Immunohistochemical analysis indicated that tumor cells were positive for CD99 and NSE, focally positive for EMA but negative for synaptophysin and chromogranin. The mass was surgically excised with negative margins. In post op period patient was planned for post-op chemotherapy and radiotherapy.

Conclusion

pPNETs are very rare in head and neck region. Significant advances in the neoadjuvant and adjuvant chemotherapeutic regimens, as well as improved facility in diagnosing these tumors through cytogenetic and immunohistochemical analysis improves the long-term disease-free survival.
External Laryngocoele or Anterior Jugular Vein Aneurysm (A Rare Clinical Entity): A Paradox Solved by A Few Simple Non-Invasive Radiological Tests
Authors: Mozumder Somesh , Dubey Shirish , Dam Aniruddha , Bhowmick Anup Kumar
Published: August 2020

Introduction

 

 

The differential diagnosis of a cystic upper neck mass that becomes prominent on coughing, straining, breath holding, or Valsalva manoeuvre includes mediastinal tumours and cysts, external laryngeal diverticula, and jugular venous aneurysms. Jugular venous aneurysms, while extremely rare, must be considered. We report the fifth case of anterior jugular aneurysm in an adult patient.

 

Case Report

 

A 55 year old female patient presented with a swelling in the upper part of right side of neck near the greater cornu of hyoid bone. The swelling increased with Valsalva, straining and while stooping forward. Clinically it was thought to be an external laryngocoele. However Colour Doppler Ultra-sonography and C.T angiogram of neck established it as of anterior jugular venous aneurysm by distinguishing from external laryngocoele.

 

Discussion

 

Patient presenting with unilateral cystic swelling in upper neck at upper border of thyroid cartilage which clinically bears the common provisional diagnosis of external laryngocele must be differentiated radiologically from anterior jugular venous aneurysm, (though rare in occurrence) to avoid a catastrophic incident during surgery.
Oral Submucous Fibrosis- Correlation between Clinical Findings and Histopathological Grading
Authors: Prabhu K , Singh Hitendra Prakash , Kumar Sunil , Maurya Malti Kumari , Verma Veerendra , Mishra Anupam , Agarwal Satya Prakash
Published: August 2020

Introduction

Oral Submucous fibrosis (OSMF) occurs in young adults, who are in the habit of chewing tobacco mixed with areca nut and its various commercially available preparations. The disease results in progressive inability to open the mouth due to the submucosal fibrosis initiated by chronic inflammation affecting mainly oral mucosa. Authors undertook the present study to correlate the clinical features of OSMF to histopathological features and to find out aetiopathological factors of this condition.

Materials and Methods

A total of 123 clinically diagnosed OSMF patients, in the age range of 17 to 70 years were studied. Mouth opening was measured using a scale and was recorded in millimeters. Incisional biopsy was taken from the representative areas in the oral cavity. The patients were graded clinically and histopathologically and results were analyzed and discussed.

Result

Most of the patients were in the age group of 20-30 years (37.4%) with male predominance. The duration of either tobacco or areca nut chewing ranged from 1 to 35 yrs. Most patients had these habits for 6-19 yrs. Majority (55.3% & 54.5%) of the patients belonged to grade-2 (clinical grading) and intermediate grade (HPE grading) respectively. The HPE grading showed significant and direct association with duration of ill habits. The HPE grading showed significant and direct association with clinical grading (χ2=204.08, p<0.001).

Discussion

The HPE grading showed significant and direct association with duration of ill habits and also with clinical findings of restriction of mouth opening and inter incisal distance. The HPE findings showed significant and direct association with clinical grading i.e. when the clinical grading increases, the histopathological grading also increases.

Conclusion

OSMF is a disease with a high incidence. It also carries a significant risk of transformation to oral cancer. As no effective medical and surgical treatment is available for this condition; it is desirable to diagnose OSMF at early stages.
Correlation of Clinical and Endoscopic Evaluation with PET-CT in Detecting Recurrence of Head and Neck Squamous Cell Carcinoma
Authors: Mappuri Rambabu , Narayanaswamy Ramakrishnan
Published: August 2020

Introduction

The current study reports the correlation of clinical and endoscopic evaluation with 18F-Fluorine Fluorodeoxyglucose Positron emission tomography/Computed tomography (18F-FDG PET/CT) findings in detecting the residual/recurrence tumor after definitive treatment in the follow up cases of squamous cell carcinoma head and neck.

Materials and Methods

A prospective comparative study carried out on 30 follow-up cancer patients after definitive primary treatment. All patients were evaluated by clinical examination, endoscopy and 18F-FDG PET/CT and these results correlated to detect residual/recurrence. Suspicious lesion at primary site suggesting residual/recurrence was confirmed by gold standard investigation, histopathological examination (HPE).  

Result

The age group mostly involved is 40-70 with male predominance. Predominant sites were oral cavity and larynx. 20 patients showed recurrence on clinical and endoscopic evaluation with 03 false positive results, 10 patients showed no recurrence with 01 false negative result. On PET/CT, 19 patients were showed recurrence with 01 false positive result, 11 patients showed no recurrence. PET/CT showed high sensitivity, specificity, with high NPV in detecting the recurrence of disease in the follow up period. Clinical and endoscopic evaluation also has high sensitivity, PPV and NPV.

Conclusion

It is recommended that 18F-FDG PET/CT scan should be done in every case after primary treatment in addition to complete clinical and endoscopic evaluation and during follow-up period for early detection and management of residual/ recurrence.
Novel Therapy for Pseudocyst of Pinna – An Institutional Study
Authors: Chakraborty Debdulal , Das Chiranjib
Published: August 2020

Introduction

Pseudocyst of pinna is a cystic swelling with collection of serous fluid between the auricular cartilage and perichondrium. Successful treatment of pseudocyst of pinna is challenging because of its high propensity for recurrence and cosmetic deformity. None of the treatment modalities described in literature gives fully satisfactory result. So a novel treatment modality is required which gives good cosmetic outcome with zero recurrence.

Materials and Methods                                                       

A prospective study was done in the Department of ENT and Head and Neck Surgery of a Government Medical College, West Bengal from April 2014 to March 2017. The effusion was aspirated aseptically with sterilized 10 ml syringe with 18G IV needle. An equal amount of Inj. Dexamethasone and Inj. Gentamicin 80 mg in 1:1 ratio mixed in a new 10 ml syringe was injected into the swelling through the same prick point.

Result

Most of the patients in this study were males between 31-40 years of age and labourer by profession. Maximum number of patients had swelling involving concha. Only one case of one month old infant had bilateral involvement. All patients were cured without any recurrence or disfigurement.

Conclusion

The results of present study points to the fact that aspiration and instillation of equal amount of Inj. Dexamethasone and Inj. Gentamicin works very good in treatment of pseudocyst of pinna. This therapy is minimally invasive, less painful, cost-effective and less cumbersome for the surgeon. It gives faster recovery, good cosmetic outcome and recurrence is prevented.
Facial Plexiform Neurofibromatosis Type I
Authors: Devnath Bapan , Dey Debraj , Ghosh Avinava
Published: August 2020

Introduction 

Plexiform neurofibroma is a benign tumor of peripheral nerves arising from a proliferation of all neural elements. Clinically, it presents as a subcutaneous mass which feels like a "bag of worms".

Case Report 

A 23-years-old male with a swelling over left side of the face large enough to involve whole one side of the face. There was tenderness and the swelling had a very peculiar consistency, soft in most of the areas with few firm nodular areas.

Operative procedure: surgery was done in two stages. Initially subtotal excision was done and 3 months later re-explored to excise the recurrent disease. Complete excision was not possible.

Discussion

Plexiform neurofibroma (PNF) occurs due to overgrowth of neural tissue in the subcutaneous region. Surgical management remains the mainstay of treatment but functional disturbances are almost inevitable while resecting tumors involving the head and neck region. Resection and de bulking of invasive PNF is however associated with a high rate of recurrence. One of the limiting factors is vascularity of these lesions and their abnormal propensity to bleed.

Conclusion 

Although benign, plexiform neurofibromas can cause pain, disfigurement and functional changes and more importantly, may turn malignant. Surgery should be attempted considering psychological benefits.
Cosmetic Disfigurement due to Home Remedy in Melanocytic Nevi
Authors: Kalra Riya Kaur , Singh Phulwinder
Published: August 2020

Melanocytic nevi of the head and neck region are common among all ages with no predilection for males or females. These moles can appear as small, dark brown spots on the skin anywhere on the face including the eyelids, which may not be cosmetically acceptable.

Case Report

Here we report a case where a toilet cleaner (tezaab) was used to remove the facial mole leading to scar formation, which otherwise could have been removed with various latest modalities with no residual scar.

Discussion

Melanocytic nevi can be removed safely by the latest modalities available by the trained professionals but at times people try  home remedies or take internet suggestions before consulting a doctor which can lead to ugly scars.
Rare Cases in ENT
Authors: Pal Kalyan , Chakraborty Dipanjan , Kundu Sohag , Mukhopadhyay Subrata
Published: August 2020

In our day to day ENT practice we commonly come across diseases involving the larynx, the oral cavity and the paranasal sinuses. These range from inflammatory disorders to benign and malignant neoplasms. Carcinomas involving the head and neck region are most commonly squamous cell carcinoma. However, a small proportion of cases present with other variants of carcinoma or infective pathology uncommon for the site. In this study we present three rare cases encountered in the out-patient department, namely, Primary Malignant Melanoma of the larynx, Neuroendocrine Tumor of the nose and paranasal sinuses and Rhinosporidiosis of cheek.
All Cartilage No Stitch Type 1 Tympanoplasty – A Prospective Study
Authors: Chakraborty Debdulal , Das Chiranjib , Chatterjee Pritam , Hansda Rajesh
Published: August 2020

Introduction

Although temporalis fascia is the commonly used graft material for tympanoplasty, cartilage has become the material of choice in cases with eustachian tube dysfunction, bilateral disease, total or anterior perforation of tympanic membrane, tympanosclerosis etc. Cartilage slices < 0.5 mm thick are similar to the tympanic membrane in their acoustic properties. The present study is aimed to describe stitch-less type 1 tympanoplasty with sliced tragal cartilage-perichondrium and evaluate anatomical, audiological and cosmetic outcomes.

Materials and Methods

A prospective study was conducted from March 2014 to August 2016, in ENT department of a Government Medical College and Hospital, West Bengal, India. Primary tympanoplasty cases irrespective of age, size and site of perforation, laterality and eustachian tube function were included in the study. History of previous tympanoplasty or mastoid surgery and cases requiring ossicular reconstruction or mastoidectomy were excluded from the study. Sliced tragal cartilage-perichondrium graft of 0.2 mm thickness was placed in underlay fashion through trans-canal or end-aural route.

Results

Among 95 cases 38 were male, 57 were female with age range between 7 to 68 years. Average operative time was 30 minutes. Graft take was successful in 97.89% of cases. Average Air Bone Gap 12 months after operation was 13.03dB.

Conclusion

Sliced cartilage-perichondrium graft gives good balance between sufficient stability and adequate acoustic sensitivity. Moreover, no stitch technique reduces operative time and increases cosmesis.
Comparison of Microdissection Microlaryngeal Surgery with Carbon Dioxide Laser in Management of Benign and Premalignant Lesions of Larynx
Authors: Prasad Rachana , Mallick Ajay
Published: August 2020

Introduction

Dysphonia is caused by voice misuse and various environmental factors. It is   manifested as varied pathological lesions of the vocal cords. Surgical excision of these lesions is mainly by conventional cold steel or laser assisted microsurgical techniques. Both modalities have seen extensive advancements and refinement in technologies in the recent past. In this study we have compared the microdissection microlaryngeal treatment and microspot superpulsed beam carbon dioxide (CO2) laser assisted surgical techniques for the management of benign and precancerous lesions of the vocal cords.

Material and Methods

A total of 36 cases of benign lesions of vocal cord, were divided randomly to undergo surgery either by microdissection or CO2laser assisted techniques. The groups were assessed through vocal cord morphological observation and subjective voice assessment parameters GRBAS score and VHI10 index.

Results

Peroperative bleeding was observed to be significantly reduced in the laser excision group.  However, operating time was significantly increased in this group. Patients recovered remarkably well following both the techniques as denoted by voice parameters. No difference was observed in duration of hospital stay. 

Conclusion

Both surgical techniques give satisfactory results in their management of benign and precancerous lesions of the vocal cords. Both techniques have their advantages and disadvantages. After a learning curve, laser surgery with its precision and cleaner surgical fields will be more effective in the management of such cases.
A Cadaveric Study of Occurrence of Extralaryngeal Branches of the Recurrent Laryngeal Nerve with Reference to its Importance in Thyroid Surgery
Authors: Nandy Shantanu , Banerjee Anirban , Das Saumik
Published: August 2020

Introduction

Recurrent Laryngeal Nerve Palsy (RLNP) is the most common complication of thyroid surgery. Patients complain of hoarseness of voice and sometimes variable amount of respiratory distress due to palsy of recurrent laryngeal nerve (RLN), extra laryngeal branches of which are often ligated along with Inferior Thyroid Artery (ITA) during thyroidectomy. So prevalence and variable pattern of extra laryngeal nerve branches (ELNB) of RLN should be known to the thyroid surgeon to avoid post operative complications.

Materials and Methods  

Dissection was carried on the neck of properly embalmed 25 adult cadavers including both sexes in the dissection hall to study extra laryngeal nerve branches (ELNB) of 50 RLN specimens.

Results

Out of 50 RLN, 13 nerves (26%) have ELNBs. Only in 4 cadavers (16%) they are bilateral. In 9 cases RLN branches were surrounding either single trunk of ITA or branches of the artery. In rest of the 4 cases ELNBs were passing entirely either in front or behind the ITA

Conclusion

The gold standard for preservation of the RLN during thyroid surgery is still visual anatomical identification. Proper dissection and anatomical identification of the RLN and all its branches is very important prior to the clamping of the ITA and all its branches.
Comparative Study of Infiltration of Lidocaine with Adrenaline versus Sterile Water in Type 1 Tympanoplasty Performed under General Anaesthesia
Authors: Pandurangarao Santosh Uttarkar , Janarthanan Sridurga
Published: August 2020

Introduction

It is a common practice to infiltrate 2% lignocaine with 1:2,00,000 adrenaline for Type 1 Tympanoplasty, even when the surgery is done under general anaesthesia. The purpose of this study is to evaluate the necessity of infiltration of lidocaine with adrenaline (2% lidocaine with 1:2,00,000 adrenaline) in Type 1 Tympanoplasty surgeries performed under general anaesthesia in terms of per-operative bleeding and post-operative pain relief.

 

Materials and Methods

A double blinded, prospective randomized comparative study was conducted in a tertiary care centre. A total of 50 patients planned for Type 1 Tympanoplasty under general anaesthesia, for chronic otitis media, inactive, mucosal disease were selected and divided into two groups randomly. Group A (25 patients) received local infiltration of 2% Lidocaine with 1:2,00,000 adrenaline and Group B (25 patients) patients received infiltration of sterile water. The per -operative bleeding and post-operative pain relief were assessedat 2nd, 4th and 6th post-operative hour in both the groups and the results were analysed.

 

Results

P value for per operative bleeding was <0.77 (non-significant). And the P value for post-operative pain relief at 2nd hour was <0.002 (significant). But the P value for 4th (<0.133) and 6th (<0.358) post-operative hours were not significant.

 

Conclusion

Infiltration of 2% lidocaine with 1:2,00,000 adrenaline, doesn’t have any significant impact in per-operative bleeding and post-operative pain relief at 4th and 6th hour. But there is a significant pain relief, for 2 hours after surgery, when 2% lidocaine with 1:2,00,000 adrenaline is used for infiltration.
Tongue Entrapment in a Plastic Bottleneck
Authors: Singh Ram Rajmani , Gosrani Nikesh Meghji , Patel Tejal , Shah Khitij Dhaval
Published: August 2020

Introduction

Oral foreign bodies and perioral injuries are common occurrence among paediatric population. These may range from benign occurrences to those that may threaten the airway. One such injury is tongue entrapment into objects like plastic bottle neck. Tongue entrapment in bottle neck is rare with very few cases reported in literature.

Case Report

A case of a 9-year old mentally retarded male child with tongue haemangioma who got his tongue tightly entrapped inside a plastic bottle neck is presented. Since such cases are very rare, treatment often requires creative and novel approach to ensure safe removal of constricting object without causing any injury to surrounding structures. When conventional methods using Mayo’s scissors failed to cut open the bottle neck, we used Gigli saw wire in a safe manner to cut it open. It took a few minutes to relieve the entrapment of tongue   without traumatising the surrounding structure.

Discussion

This case highlights the result of careless and often dangerous play and misadventures of children and the challenge of management. It calls for vigilance and close supervision of children by caregivers at home and at school. Early presentation, immediate intervention and treatment can prevent grave consequences.