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Intl. J. of Advances in Medicine     Open Access   (Followers: 1)
Intl. J. of Basic & Clinical Pharmacology     Open Access   (Followers: 2)
Intl. J. of Clinical Trials     Open Access   (Followers: 2)
Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 5)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 3)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access  
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 10)
Intl. J. of Research in Dermatology     Open Access   (Followers: 1)
Intl. J. of Research in Medical Sciences     Open Access   (Followers: 2)
Intl. J. of Research in Orthopaedics     Open Access  
Intl. J. of Scientific Reports     Open Access   (Followers: 1)
Intl. Surgery J.     Open Access   (Followers: 1)
Journal Cover International Journal of Otorhinolaryngology and Head and Neck Surgery
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   ISSN (Print) 2454-5929 - ISSN (Online) 2454-5937
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  • Therapeutic interventions in vertigo management

    • Authors: Mohan Kameshwaran, Kushal Sarda
      Pages: 777 - 785
      Abstract: Vertigo is a condition associated with a spectrum of symptoms and ~30% of general population experience vertigo in their life time. In spite of being of high clinical importance, the management of vertigo is quite challenging. Though the literature supports the availability of various therapeutic interventions used in vertigo treatment, their effectiveness depends on accurate diagnosis, appropriate use of intervention, and physician’s awareness of the overlap between vestibular, autonomic, and psychological aspects of vestibular pathology. Unfortunately, several drugs act as tranquilizers and impede the process of vestibular compensation. Betahistine, a histamine analogue, is one of the most commonly used anti-vertigo drugs worldwide and has been supported by many clinical trials. There have been several oral communications in international conferences on the efficacy of using betahistine in several clinical vertiginous syndromes. The current review assesses the use of betahistine 48 mg twice daily for three months as an efficient and well-tolerated treatment for vertigo. Additionally, it highlights the low incidence of side effects even at high doses of betahistine and suggests that it may be considered as the first-line of treatment for vestibular dysfunction.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Relation between deviated nasal septum and paranasal sinus pathology

    • Authors: Ibrahim Sumaily, Jibril Hudise, Saud Aldhabaan
      Pages: 786 - 790
      Abstract: Background: Deviated nasal septum is a very common finding in ENT clinic, most of the times, as incidental findings without any related symptom. Sometimes it present in association with suspiciously related sinusitis. Our study is to identify the possible association between deviated nasal septum and sinusitis, so that we can consider septoplasty alone a first surgical management for these cases without any sinus procedure or not. Methods: A cross sectional case-control study. SPSS.v22 used for data analysis. We used Kuhn-Kinnedy staging system for sinus pathology and applied it on the osteomeatal complex (OMC) and all paranasal sinuses. Those patients with deviated septum were studied for sinus disease especially maxillary and anterior ethmoid sinuses, and those with sinus disease were studied for deviated septum.  Results: We studied 238 patients, 120 males and 118 females, of them 164 (control) found to have central septum (68.9%) and 74 (cases) found to have deviated nasal septum (31.1%), 42 to the right and 32 to the left. 104 candidates (43.7%) found to have sinus disease. All findings were almost equal in both genders. Of the total sample, 40% of those with central septum found to have patent OMC and normal sinus mucosa equally. Of those who have DNS (74 candidates), OMC found to be opacified in 13.5% in the ipsilateral side, and 27% bilaterally. In those with DNS maxillary sinus was diseased in 20.3% ipsilaterally, 21.2% contralaterally, and 18.5% bilaterally. Anterior ethmoid sinuses were similarly affected in 40.5% ipsilateral and contralateral to DNS. Conclusions: According to our finding, no significant association between deviated nasal and paranasal sinusitis. Attributing sinuses disease to deviated nasal septum may lead to over treatment of the patient and unnecessary surgery. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Prevalence and pattern of neck masses in pediatric patient: in Aseer
           Central Hospital, KSA

    • Authors: Jibril Yahya Hudise, Khalid Ali Alshehri, Radeif Eissa Shamakhey, Ali Khalid Alshehri
      Pages: 791 - 794
      Abstract: Background: Neck masses are a common complaint in children worldwide, and constitute a major indication for surgical consultation in many pediatric surgical centers. Most of the neck masses in children are benign in their nature and clinical course. The broad spectrum of etiology of neck masses that ranged from congenital benign to acquired neoplastic lesions is varied and related to multiple factors. This retrospective study was done with the objective to assess the distribution of neck masses related to gender, age, pathology, and anatomical location of neck masses in Aseer Central Hospital. Methods: Medical records of 62 patients with neck masses were collected from the department of pathology at Aseer Central Hospital KSA. The cases were reviewed for data on gender, age, the type of origin tissue, the type of lesion, and the anatomical location. Comparison between genders, age groups, and tissue origins were performed. All statistical tests were performed with SPSS software. We exclude thyroid, parathyroid and salivary gland masses.  Results: Over a period of 5 years, a total of 62 patients 53.2% and women 46.8% had neck masses resected for pathological assessments. The age of presentation was ranging from 1 to 14 years. 22.6% developed in (from 1 years to 5 years old), 38.7% developed in (6 to 10 years), and 38.7% developed, in (11 to 14 years). The histopathological diagnosis of the neck masses were congenital 40.3%, inflammatory 33.9%, and malignant tumor 25.8%. Conclusions: The differential diagnosis of the pediatric neck mass includes a wide array of congenital, inflammatory, benign and malignant lesions. The exact diagnosis may only be obtained by histopathological examination. In our study the most common masses in pediatric patient thyroglossal duct cyst, all midline masses are congenital.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinocpathological study of tumours of maxilla

    • Authors: Udaya Kumar M., Kranti Gouripur, S. Elangovan, V. Srinivasa
      Pages: 795 - 801
      Abstract: Background: Malignant neoplasms of the nose and paranasal sinuses are rare and account for 3% of malignancies involving head and neck region. Maxillary sinus is the commonest area affected and squamous cell carcinoma is the commonest malignancy reported. Due to nonspecific clinical features, late presentations and poor accessibility tumours in these areas are both therapeutically and diagnostically challenging. Data about maxillary sinus tumours, especially from Karaikal are lacking. This prospective hospital-based study was conducted to determine the common benign and malignant tumours affecting the maxilla, their epidemiology and to analyse their clinical presentations.Methods: Relevant epidemiological and clinical details were collected for all the patients with maxillary tumours and thorough clinical evaluation was performed. CT scan of head and neck region and histopathological examination of the lesion was carried out. All the details were tabulated and percentages were calculated for comparison and analysis.  Results: During two years period of the study 44 patients with tumours affecting the maxilla were detected, 32 (72%) being benign and 12 (27%) malignant. Incidence of both benign and malignant tumours was highest in the 51-60 years age group with male preponderance. Squamous cell carcinoma (58.33%) was the most common malignant histological variant found while inverted papilloma with squamous epithelium (62.5%) was the most common benign histological variant. In TNM staging, 42% patients had T4 and the remaining were T3 and T2. Conclusions: In Karaikal region, inverted papilloma with squamous epithelial lining and squamous cell carcinoma are the commonest benign and malignant tumours of maxilla respectively. Although clinical manifestations of both benign and malignant lesions overlap, certain features like facial pain, cheek swelling, loosening of teeth which were found only in association with carcinoma should warrant thorough evaluation.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinical profile and management options in patients of Ludwig’s angina:
           a 5 year prospective study

    • Authors: Smruti Milan Tripathy, Harikumar B.
      Pages: 802 - 806
      Abstract: Background: The objective of the study was to study the etiology, clinical presentation, bacteriology and management options in 38 cases of Ludwig’s angina. Methods: 38 patients of Ludwig’s angina admitted in ENT Department of Saveetha Medical College, between March 2012 to April 2017, were included in the study. Various parameters like etiological agents, clinical features and management options were analysed.  Results: Ludwig’s angina was found to be more prevalent between age group of 41 to 70 years with a mean age group of (60.3yrs). Males were found to be more commonly affected (71%) as compared to females (29%). Odontogenic infections still accounted for majority (81%) of causes with uncontrolled type 2 diabetes mellitus emerging as the main associated comorbidity. Patients mainly presented with symptoms like submental and submandibular swelling (100%), dysphagia (67%), odynophagia (55%), and stridor (42%). Almost all the patients required intravenous antibiotics, analgesics and steroids (100%) with (82%) requiring tooth extraction and (74%) requiring incision and drainage. Among the patients who presented with stridor (29%) underwent tracheostomy for airway management. The culture of the discharge obtained after incision and drainage found pseudomonas (71%), staphylococcus aureus (34%) and beta hemolytic streptococcus (42%) as common microbial agents. Conclusions: Ludwig’s angina is a serious and life threatening condition which can have fatal outcome if not treated aggressively, therefore a thorough understanding of the clinical presentation, common etiological factors, microbial agents and treatment methods is needed to manage these patients. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinical and epidemiological profile of patients with nasal manifestations
           of granulomatous disorders in a rural tertiary care centre

    • Authors: Mohit Sinha, Narendra Hirani, Ajeet Kumar Khilnani, Yash Dhamecha, Jitendra Pareek
      Pages: 807 - 811
      Abstract: Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist.  Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.Conclusions:Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment. Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist.  Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.Conclusions: Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Tuberculosis in otolaryngological practice

    • Authors: Girija A. Ghate, Paresh S. Chavan, James Thomas, Mayur H. Ingale
      Pages: 812 - 815
      Abstract: Background: Tuberculosis has become a common occurrence in Otorhinolaryngology with increasing number of extra pulmonary cases. Methods: This is a study of 27 patients who visited ENT OPD of Dr. D. Y. Patil Medical College, Pune, with variety of manifestations of tuberculosis in the ENT region.  Results: Majority of those suffered from tuberculous cervical lymphadenopathy, other manifestations included laryngeal tuberculosis, tuberculous otitis media, lupus vulgaris and tuberculous infection of a pre auricular sinus. FNAC and histopathologic examination proved to be reliable tools of diagnosis. Five of these patients suffered from concurrent pulmonary tuberculosis. All these responded well to category 1 anti-tubercular therapy well. Conclusions: Tuberculosis in Otorhinolaryngology shows a variety of manifestations so it should be kept in mind whenever dealing with unusual presentations.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • An observational study of benign oral lesions in central India

    • Authors: Prashant N. Keche, Nishikant P. Gadpayle, Surendra H. Gawarle, Gaurav A. Chamania
      Pages: 816 - 820
      Abstract: Background: The oral mucosa serves as a protective barrier against trauma, pathogens and carcinogenic agents. It can be affected by a wide variety of lesions and conditions, some of which are harmless while others may have serious complications. The appearance of benign oral soft tissue masses can occasionally resemble malignant tumors. Methods: Present study is an observational and cross sectional study under taken in the Department of ENT in Shri Vasant Rao Naik Government Medical College, Yavatmal. All cases of benign oral lesions were included in the study and following cases were excluded: malignant oral lesions, immunocompromised state and benign Oral lesions due to systemic diseases.  Results: Present study included 235 lesions of oral cavity which were clinically or histo-pathologically found to be benign in nature. Benign oral lesions were more commonly found in males with (70.2%) than females (29.8%), and M:F ratio was 2.3:1. most common benign oral lesions were found to be Oral Sub Mucus Fibrosis (26.8%) followed by Apthous ulcers (20.4%), Leukoplakia (18.3%) and Mucocele (17.1%). Least common benign oral lesions were found to be Minor Salivary Gland Tumor (MSGT) (1.7%) followed by Squamous Papilloma (2.1%), Ranula (2.1%) and Hemangioma (2.1). There was a male predominance in oral sub mucus fibrosis with M:F ratio of 9.5:1 followed by Leukoplakia with M:F ratio of 4.4:1. OSMF was found most commonly in 21-30 years age group with (57.1%). Followed by 11-20 years with (20.6%). No cases were found in ≤10 years, 51-60 and >60 years age group. Conclusions: Most of the benign oral lesions have a predilection to transform into malignant lesions therefore imperative to diagnose the pre malignant lesions of oral cavity in an early stage where appropriate treatment can be given.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Assessment of short term hearing improvement in patients of cartilage
           interposition ossiculoplasty for lenticular process of incus necrosis in
           cases of chronic suppurative otitis media: mucosal disease

    • Authors: Shashikant K. Mhashal, Neeraj R. Shetty, Amit S. Rathi, Vinod A. Gite
      Pages: 821 - 825
      Abstract: Background: Chronic suppurative otitis media is a highly prevalent disease in developing countries. Hearing loss associated with this disease is significantly more in cases associated with ossicular necrosis along with tympanic membrane perforation. Methods: We would like to present a study of such cases of mucosal chronic suppurative otitis media associated with lenticular process necrosis treated by cartilage interposition ossiculoplasty. The patients were followed up for a minimum period of 6 months and their pre op and post op hearing was documented and analyzed.  Results: An average air bone gap of 39.07 decibels in pre op was reduced to 18.13 decibels in post-operative period and these improvements persisted over 6 months of follow-up. Conclusions: We have hereby concluded that the hearing improvement is comparable to other methods of ossiculoplasty with minimum disruption of natural hearing assembly in lenticular process of incus necrosis. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A cross sectional study of clinical profile of deaf mute children at
           tertiary care center

    • Authors: Apurva Pawde, Rajeshree Chaurpagar, Sumit Aggarwal, Arpana Agrawal, Sandeep Dabhekar
      Pages: 826 - 832
      Abstract: Background: Hearing is necessary to learn language, speech and to develop cognitive skills. Hearing helps in developing child to learn, recognize sounds, identify objects, events and internalize concepts. Effects of hearing loss on the development of child’s ability to learn, to communicate and to socialize can be devastating. The study is planned with the aim to study clinical profile of deaf mute children and to identify ‘socio-demographic’ and ‘health’ profile of deaf mute children. This study shows distribution of various socio-demographic factors in deaf mute children and to study their clinical profile. Methods: The present cross sectional descriptive study was conducted at OPD of ENT department, Government Medical College and Hospital, Akola, Maharashtra. Study was carried out for a period of two months, it’s included Deaf mute children from 2-12 years of age. 50 subjects were reported over the study of 2 months. For data collection demographic parameters, complete birth history including prenatal, perinatal and postnatal history was noted. Thorough clinical examination was carried out with special attention to branchial arch system.  Results: There were 70% males compared to 30% females. Male: female ratio was 2.33: 1. Pneumonia (10%) and hyperbilirubinemia (10%) was the commonest health problem. In the study deafness were attributed to 38% genetic causes, 28% Non-genetic and idiopathic in 34% of children. Conclusions: The age at detection of hearing loss is 0-2 yrs age at which if rehabilitation is done can benefit the child to the maximum. Delayed diagnosis of hearing loss can be explained on basis of community practices of neglecting delayed speech, lack of social awareness and partly due to absence of any active health surveillance in this aspect. Multistep protocol for hearing assessment and parental awareness about facilities of rehabilitation and accessibility of services should be emphasized.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinical benefits of surgical management of concha bullosa

    • Authors: Kulwinder Singh Mehta, Aamir yousuf, Iftikhar Ali Wazir, Kouser Sideeq
      Pages: 833 - 836
      Abstract: Background: Concha bullosa is a common anatomical variation in nasal cavity, responsible for headache, Rhinogenic origin is an important cause for headache wrongly managed now a day, which may be treated by medical or surgical intervention, proper diagnosis and patient’s selection is very important to achieve good results with surgery of CB. The aim of this study is to evaluate the efficacy and assess the clinical benefits outcome results of our endoscopic turbinoplasty technique for CB. Methods: This study was done in SMHS GMC Srinagar for a period of one year and about 30 patients with mild/moderate DNS and associated CB with symptoms of facial pain, head ache, nasal obstruction, anosmia, recurrent rhinitis were selected for surgical management and symptoms assessment was done using VAS.  Results: The 30 patient group with 1: 1 male: female ratio predominatly in 3rd decade of life presented with nasal obstruction more on concha bullosa side, 26 with facial pain and 27 patients with head ache and nasal obstruction, anosmia/hyposmia in 20 and recurrent rhinitis in 26. There was statistical significant benefit on symptoms score in patients managed with endoscopic chonchoplasty. Conclusions: The endoscopic turbinoplasty is safe and efficacious procedure for concha bullosa and is causuative factor for rhinogenic origin of headache and facial pain.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Management of sudden sensorineural hearing loss: a prospective study of 30

    • Authors: Sunil N. Khot, Priyadarshini G., Ayisha Kunnumal
      Pages: 837 - 841
      Abstract: Background: Sudden sensorineural hearing loss (SNHL) is sensorineural hearing loss of 30 dB or more over at least three contiguous audiometric frequencies that develop over a period of few hours to three days. The purpose of study is to make a protocol for treatment.Methods: 30 cases of sudden SNHL who presented to OPD of Government Medical College, Miraj between December 2015 to April 2017 were included. Detailed history taking and ENT examination was done. All patients were admitted and started on intravenous methylprednisolone. If hearing improvement was not observed, intratympanic methylprednisolone (ITS) was administered.  Results: 50% patients had recovery with intravenous Methylprednisolone and 50% had no recovery. “No recovery” patients were subjected to ITS, of which 20% had complete, 30% partial and 50% no recovery. Among no recovery patients of ITS, 10% had hearing loss greater than 90 dB with improvement rate of 0%; 40% had hearing loss of 90 - 50 dB with improvement rate of 50%; 50% had hearing loss of 50-30 dB with improvement rate of 60%. Among 15 cases of ITS, mean number of days between onset of symptom and starting ITS was 13 days for complete recovery patients; 17.3 days for partial or slight recovery; 20.6 days for no recovery.Conclusions: Hearing loss less than 90 dB and earlier ITS has positive influence on hearing recovery. Systemic steroids are currently the mainstay of initial treatment. ITS is an effective treatment modality for patients who fail to respond to systemic steroids.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Prevalence and clinical features of nasal septum deviation: a study in an
           urban centre

    • Authors: Vinnakota Sriprakash
      Pages: 842 - 844
      Abstract: Background: Considerably large nasal septum plays a critical role in the obstruction of the nasal cavity, leading to snoring, and other symptoms, aesthetic appearance of the nose, and increased nasal resistance. This study was performed with an aim to investigate the prevalence of nasal septum deviation in our geographical area.Methods: 446 patients who attended the ENT department in the study period were evaluated for the nasal septum deviation. General demographic details were obtained from all of them. Detailed physical exam was performed on all the patients. Disposable nasal speculum and otoscope was used to observe the interior of the nasal cavity.  Results: Out of 446 patients visiting the ENT department of our hospital, 138 (30.9%) of them had DNS. The C shaped NSD was the most common type to be encountered in our study, with 57 patients showing this disorder. Nasal obstruction was the predominant symptom observed in 119 (86.2%) of the patients, followed by rhinitis and nasal discharge (34.8%).Conclusions: Deviated nasal septum is a very prevalent condition in our area, with severe symptoms such as nasal obstruction and rhinitis. Most of the patients had C shaped deviated septum.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A clinical study on laryngeal manifestations of tuberculosis

    • Authors: Valli Rajasekaran, Srividhya G.
      Pages: 845 - 848
      Abstract: Background: In the recent years there is resurgence of tuberculosis and the presentation of the same has changed. Vocal cord paralysis can be due to involvement of vagus anywhere along its course. The lesions in the larynx can be the earliest presentation of tuberculosis. Methods: A study has been done on all patients with tuberculosis with laryngeal lesions due to tuberculosis for a period of 6 months. These lesions were followed up and the resolution of these lesions and symptoms were documented.  Results: Vocal cord paralysis was the most common manifestation (66.6%). Tuberculosis of the larynx can be secondary to pulmonary tuberculosis or a primary manifestation. Vocal cord paralysis on the left side was due to mediastinal lesions and on the right side was due to apical fibrosis. Conclusions: Vocal cord lesions due to active tuberculosis either nodal or parenchymal involvement usually recover completely with treatment. On the other hand, the lesions due to inactive lesions are likely to be permanent.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • MVD for trigeminal neuralgia; neuralgia revisited with review of

    • Authors: Renuka S. Melkundi, Sateesh Melkundi
      Pages: 849 - 853
      Abstract: Background: Trigeminal neuralgia (TN) s an uncommon facial pain syndrome. It is commonly characterized by sudden onset of an attack of intense electric shock like facial pain localized along the sensory distribution of the ninth cranial nerve. Although many patients respond to the medical line of treatment but when PTS symptoms become intractable and could not tolerate the medications have to go for surgical decompression. Our study aims to review about micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature. Methods: It is a retrospective study conducted on 40 cases who were diagnosed with TN. between the period of July 2009 to July 2015. MVD has been performed on all the patients. Demographic data, clinical presentation, surgical findings, complications and long term follow-up were reviewed.  Results: The median age of onset of TN is 50.4 years divided into five age groups ranging from 24 to 89 years with female preponderance showing 65.5% as compared to males. The distribution of location was in the ratio of right to left is 1.5:1. There was no mortality is seen in the study. 3 patients among them study population had complications 3 patients had facial hyposthesia, 1 patient had V3 paresis and 1 patient had CSF otorrhoea which got settled with drainage LP. All the patients had satisfactory improvement except one patient who had persistent pain. Conclusions: To conclude micro vascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN who is fit for surgery. Of all the currently available surgical methods MVD provides the highest rate of long term satisfaction for the patients and offers the lowest rate of pain recurrence.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Complications and management of otitis media in children

    • Authors: Parameshwar Keshangari, Pampapathi Goud Katakam, Nagababu Pyadala
      Pages: 854 - 856
      Abstract: Background: Otitis media is a main cause of hearing difficulty in children. The aim of this study was to determine the efficacy of medical treatment in the management of otitis media. Methods: This cross sectional study was conducted at the department of ENT, MNR Medical College and Hospital, during the period of February 2015 to March 2017. A total of 62 patients were included in this study and standard medical treatment of otitis media was given. All the data were recorded and analyzed.  Results: Among 62 patients, 42 (67.7%) completely recovered from the disease while 20 patients (32.25%) did not improve. Conclusions: Conservative treatment is effective in the management of otitis media.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Use of mitomycin c versus gentamicin and dexamethasone in endonasal
           endoscopic dacrocystorhinostomy

    • Authors: Aniket R. Buche, Sachin H. Garud, Surendra H. Gawarle, Gaurav A. Chamania
      Pages: 857 - 860
      Abstract: Background: Dacrocystorhinostomy (DCR) is the procedure done to drain the lacrimal sac in cases of nasolacrimal duct obstruction or in chronic dacrocystitis. New advancements in nasal endoscopic surgeries have given results comparable to external DCR. This is a prospective, case control, randomized, double blinded study to compare efficacy of mitomycin c local application versus gentamicin + dexamethasone local application intraoperatively.Methods: Fifty two patients who underwent endonasal endoscopic DCR at our Tertiary care centre between October 2015 and February 2017. All patients were operated by a single surgeon with double blind method of assigning case. In 26 patients pledgets soaked with 0.4 mg/ml mitomycin C were kept over operative site for 10 min and in other 26 patients pledgets soaked with gentamicin and dexamethasone. Post operatively patients were assessed after 1st and 2nd week and 1st and 3rd month after surgery; post-operative complaints of epiphora were graded.  Results: Maximum patients belonged to the age group of 31-60 yrs (78%), females constituted the majority with n=36 (69%). At the end of the study Group A had 92% success and Group B had 85% relief in complaints.Conclusions: We have found statistically insignificant difference between the outcome of local application of Mitomycin C and Gentamicin and dexamethasone. Thus it can be used as substitute or adjuvant with mitomycin C in the intraoperative procedure.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A study on evaluation of pre and postoperative polysomnography for
           obstructive sleep apnea patients

    • Authors: Venugopal Mohankumar, M. K. Rajasekar, Narendrakumar Veerasigamani, M. Sivaranjani
      Pages: 861 - 867
      Abstract: Background: Obstructive sleep apnea is the most common form of sleep-disordered breathing. However, obstructive sleep apnea has been associated with much more insidious conditions, including hypertension, diabetes, heart disease, stroke, and daytime somnolence can lead to a dramatically increased risk of motor vehicle accidents.Methods: This study was conducted in our institution in 34 OSA patients. After thorough evaluation with PSG, dynamic MRI, DISE patients were treated with various surgeries depending on the level of obstruction. Commonly UPPP, ESP, zetaplasty, tonsillectomy, tongue base reduction were done either alone or in combination.  Results: Pre and postoperative polysomnograhpy for obstructive sleep apnea was evaluated and statistically analyzed. Significant proportion of patients improved both subjectively and objectively as determined by reduction in AHI from 41.73±13.94 to 15.77±9.13, reduction in ESS from 16.41+3.09 to 5.14±3.41 and reduction in snoring.Conclusions: OSA can be easily treated with proper preoperative investigations, appropriate surgery, prevention of complications and continued lifestyle modifications. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Antibiotic susceptibility pattern of organisms in chronic rhinosinusitis

    • Authors: Namit Kant Singh, Lakshmi Narayan Garg, Nitish Baisakhiya, Hitesh Kuhar, Shubhranshu Shekhar, Naiya Rao, Anshul Singh
      Pages: 868 - 873
      Abstract: Background: Chronic rhinosinusitis is an ever increasing problem faced by all sectors of the population throughout the world. Various etiologic factors have been associated with the disease entity but the main concern throughout the world is the increasing antimicrobial resistance which is leading to less compliance and higher treatment cost. Methods: A total of 60 cases and 60 controls were selected and nasal swabs were collected under endoscopic guidance from middle meatus and were sent for culture and sensitivity.  Results: The data collected showed that the most common pathogen isolated from the cases was methicillin resistant Staphylococcus aureus (MRSA) accounting for 58.33% followed by fungi and methicillin susceptible Staphylococcus aureus (MSSA). The antibiotic sensitivity showed that MRSA is having the most resistant pattern with only Vancomycin, Teicoplanin and Linezolid having 100% sensitivity followed by Rifampicin, Netilmicin and Clindamycin. Conclusions: From this study we conclude that MRSA is the most common pathogen affecting the cases of chronic sinusitis and it shows a high degree of resistance towards antibiotics which is responsible for incurring higher cost of treatment and low compliance.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparison of endoscopic underlay and microscopic underlay tympanoplasty:
           a prospective research at a tertiary care centre in Gujarat

    • Authors: Mohit Sinha, Narendra Hirani, Ajeet Kumar Khilnani
      Pages: 874 - 877
      Abstract: Background: Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive.Methods: This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient’s details regarding audiometric, oto-endoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and post-operative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test.Results: Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group.Conclusions: Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Epistaxis: etiological profile and treatment outcome in a teaching
           hospital in South India

    • Authors: Basheer N. K., Jaya C., Sabir V. T.
      Pages: 878 - 884
      Abstract: Background: Epistaxis is the most common otorhinolaryngological emergency worldwide. Minor bleeding episodes occur more frequently in children and adolescents, whereas severe bleed requiring otolaryngologic intervention often occur in older individuals. Treatment options can be conservative or surgical, the selection of which should be made considering the parameters: efficiency, complications, and cost-benefit. Methods: This was a prospective study done in 131 patients with epistaxis, in the Department of ENT, Government Medical College, Trivandrum, with the aim to determine the etiology and the outcome of the conservative and surgical management.  Results: The most common causes of epistaxis were trauma and hypertension. The age incidence increased after forty years and majority had unilateral, anterior nasal, mild-moderate bleed. 79% of the cases were managed by conservative measures as opposed to only 21% who required surgical intervention. Success rate of anterior nasal pack and cauterisation of bleeding point was nearly 84%. Conclusions: Majority of cases of epistaxis can be successfully managed by conservative measures and surgical intervention may not be necessary in most cases. Cauterization of bleeding point is the best conservative method which can be offered to the patient though anterior nasal packing still remains the most preferred method to control the bleed. The most common causes of epistaxis being trauma and hypertension, reducing road traffic accidents and lifestyle illness can reduce the incidence of nasal bleed.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparative study of FNAC and histopathology of thyroid swellings,
           diagnostic accuracy and role in its management

    • Authors: Abhay Kumar, Sunil Kumar Singh Bhadouriya, Prem Narain, Jitendra Pratap Singh Chauhan, Bhartendu Bharti, Jaypal Singh
      Pages: 885 - 892
      Abstract: Background: Even if non-surgical and non-invasive techniques can provide a diagnosis, the ultimate answer rests in the histopathological examination of the excised thyroid tissue. This study was carried out with the objective of comparing the findings of the two tests namely FNAC and HPE and suggestions for the future. Methods: This two year prospective study involved 295 outdoor cases with thyroid lesions at UPRIMS & R, Saifai, Etawah, U.P. The preoperative FNAC and postoperative histopathology reports were correlated and conclusions drawn after statistical analysis.  Results: More than half (65.4% cases) the number of thyroid FNACs were diagnosed as colloid goitre. Diagnostic categorization of 295 thyroid FNACs based on Bathesda classification showed that 239 (81.01%) cases were cytologically benign, 2 cases (0.68 %) were under atypia of undetermined significance (AUS) while six  cases (2.03%) under  the  neoplasm  category- follicular. Suspicious for malignancy category included two cases (0.68%)- hyalinizing trabecular adenoma/columnar variant of papillary carcinoma and medullary carcinoma/oncocytic neoplasm. Under the malignant category, there were fourteen cases (4.05%) cytologically diagnosed and in the inadequate/non-diagnostic category there were 32 cases (10.85%) of cases. Conclusions: FNAC is a simple, safe and cost effective modality in investigation of thyroid disease with high accuracy and specificity.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Effect of cephalometric variables in paediatric snorers

    • Authors: Himanshu Swami, Viswanathan Anand
      Pages: 893 - 897
      Abstract: Background: There is a high prevalence of snoring in paediatric age group. There are various reasons for snoring in children, the most common being adenotonsillar hypertrophy. In our study we intended to establish a relationship between craniomorphological features and snoring. Methods: The sudy objective was to determine the differences in craniofacial cephalometric variables between snoring and non-snoring children. 50 snoring and 50 non-snoring children between the ages of 6 and 12 years were selected. Non-snoring subjects were matched to snoring subjects by age, sex, and ethnicity. Children with adenotonsillar hypertrophy were excluded. Snoring was assessed using a sleep behavior questionnaire administered to parents or guardians. The cephalometric radiographs of the study subjects were traced by a single investigator, 9 measurements of hard and soft tissues were recorded. The paired Student’s t test was used to analyze the cephalometric data.  Results: Snoring children manifest a significantly narrower anterior-posterior dimension of the pharynx at the superior and most narrow widths. Snoring children also had a greater length from the hyoid to the mandibular plane. Conclusions: Snoring children appear to present craniofacial factors that differ from those of non-snoring children.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Evaluation of nose and paranasal sinus disease, anatomical variations by
           computerized tomography

    • Authors: Prakash S. Handi, Mallikarjun N. Patil
      Pages: 898 - 903
      Abstract: Background: The anatomy of paranasal sinuses is very complicated. Evaluation of the location, extent of sino nasal diseases and anatomical variations by preoperative radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.Methods: Patients with sinonasal symptoms indicating requirement of CT scan evaluation and aged more than 10 years were included in the study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions.  Results: Sinusitis (single or multiple sinus involvement), nasal polyposis, frontal mucocele and ethmoidal carcinoma with destruction of medial wall of maxilla were the pathologies observed in these CT scans with sinusitis [22 (43.1%)] being the most common pathology observed. Deviated nasal septum [21 (41.2%)] was the most common anatomical variation observed. All patients who had concha bullosa [5 (9.8%)] were observed to have sinusitis involving multiple bilateral PNS. Based on Keros’ classification, olfactory fossa depth type I was most commonly observed followed by type II and type III.Conclusions: CT scan is important in patients undergoing endoscopic sinus surgery for sinonasal diseases where it acts as a road map in identifying the presence, extent of disease and any anatomical variations. This pre-operative CT scan evaluation improves planning and helps in significantly reducing morbidity and possible complications during surgery. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Nasal flora in allergic rhinitis

    • Authors: Valli Rajasekaran, Sharath Kumar B. V., Gurumani Sriraman
      Pages: 904 - 907
      Abstract: Background: Allergic rhinitis is a common cause for recurrent rhinosinusitis. The microbiology in allergic nasal mucosa has not been much documented. The aim of the study is to identify the microbes in the middle meatus in patients with allergic rhinitis and to compare with the normal nasal flora. Methods: A cross sectional study was conducted in our institute to study the nasal microbial pattern in 50 patients with allergic rhinitis and was compared with 50 normal healthy nasal flora. Nasal swabs were taken from middle meatus under endoscopic guidance in both the groups and sent for microbial analysis.  Results: Organisms like Klebsiella, E.coli, and Staphylococcus aureus were predominant isolates in patients with allergic rhinitis, whereas Staph epidermidis were predominant in controls. Conclusions: This alteration in microbial flora could possibly explain recurrent sinonasal infections in patients with allergic rhinitis.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Prevalence and pattern of thyroid malignancy in thyroid nodule in Aseer
           Central Hospital in KSA

    • Authors: Jibril Yahya Hudise, Khalid Ali Alshehri, Saad Nasser Alqarni, Yara Assiri, Ashwaq Asiri, Bayan Aljobran, Atheer Alshehri, Fatimah Asiri
      Pages: 908 - 912
      Abstract: Background: Thyroid nodules are common in the general population, especially in women. Non palpable nodules are often found when patients undergo diagnostic imaging such as ultrasonogra­phy and computed tomography of the chest and neck. This retrospective study to assess the Prevalence of thyroid malignancy in thyroid nodule related to gender, age, and pathology, in Aseer Central Hospital KSA. Methods: During a 5-year period (2011–2016), the medical records of 319 patients with thyroid nodules were collected from the department of pathology at Aseer Central Hospital KSA. The cases were reviewed for data on gender, age, and the pathological result. All patients underwent hemi or total thyroidectomy. Comparisons between genders, age groups, and tissue origins were performed. All statistical tests were performed with SPSS software.  Results: Over a period of 5 years, a total of 319 patients: male 17.2% and female 82.8% Underwent for hemi or total thyroidectomy. The age of presentation was ranging from 14 to 80 years. Among the 319 cases of thyroid nodules 73.7% were benign nodules and 26.3% malignant nodules. Papillary thyroid carcinoma in 72.6%, follicular thyroid carcinoma 10.6%, Hurthle cell carcinoma 4.8%, anaplastic carcinoma 4.8%, thyroid lymphoma 4.8% and medullary thyroid carcinoma in 2.4%. Conclusions: Thyroid nodule is a common clinical problem and the proportion of such nodules that prove to be malignant is not small, investigations are of immense help to corroborate with the clinical and morphological finding. Papillary thyroid carcinoma most common malignant thyroid carcinoma followed by follicular thyroid carcinoma, hurthel cell carcinoma, anaplastic thyroid carcinoma, lymphoma and finally medullary thyroid Carcinoma. No significant different between male and female as risk factors for malignancy.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinico-etiopathological and management profile of laryngeal tumours in a
           tertiary care centre

    • Authors: Pooja Pal, Arvinder Singh Sood, Lavneesh Manchanda, Bikramjit Singh
      Pages: 913 - 917
      Abstract: Background: Laryngeal tumours may be neoplastic or non-neoplastic. Our study aimed to analyze the incidence, clinico-etiopathological and management profile of laryngeal tumours. Methods: This prospective study was performed on 90 cases of laryngeal tumours in the Department of Otolaryngology in a tertiary care hospital from Jan 2015 to June 2016. A detailed clinical history was taken, head & neck examination done, and supplemented with necessary imaging when required. The data thus obtained was recorded and statistically analyzed.  Results: The ratio of benign to malignant tumours was 1:4. Of the benign tumours, 59% were vocal nodules. They were most common in the third decade (23.5%) and presented with hoarseness. Most patients were housewives (29%) and were associated with vocal abuse. All cases were managed surgically. Ninety seven percent of malignant tumours were squamous cell carcinoma, and seen in the seventh decade (37%). Forty one percent were labourers, and smoking, alcohol and laryngopharyngeal reflux were the predominant risk factors. The supraglottis was the commonest site involved, and dysphagia was the predominant presenting symptom. Majority of patients (42.5%) presented with stage IV disease. Malignant tumours were treated with radiotherapy (55%), chemoradiation (44%) and surgery (1%). Conclusions: Vocal nodule is the commonest benign tumour of the larynx and presents with hoarseness. The supraglottis is the main subsite to be involved in laryngeal cancer, and presents with dysphagia. Most patients present with stage IV disease. Laryngopharyngeal reflux is an important risk factor for carcinoma larynx.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A randomized study comparing the efficacy of mometasone furoate and

    • Authors: Satvinder Singh Bakshi, Surianarayanan Gopalakrishnan, Nirmal Coumare V.
      Pages: 918 - 922
      Abstract: Background: Ocular symptoms like itching, redness and congestion are common in patients with allergic rhinitis. These symptoms affect the quality of life and increase the burden on the healthcare cost. Intranasal steroids are effective in reducing the nasal and ocular symptoms of allergic rhinitis. We aim to compare the efficacy of mometasone furoate nasal spray and fluticasone furoate nasal spray in reducing the nasal and ocular symptoms of allergic rhinitis.Methods: 90 patients with perennial allergic rhinitis and ocular symptoms were randomly divided into 2 groups. Group A (n=46) received 200 µg of mometasone furoate nasal spray once daily and Group B (n=44) received 110 µg of fluticasone furoate nasal spray daily. The patients were assessed by total ocular symptom score [TOSS] and total nasal symptom score [TNSS] at 2, 6 and 12 weeks interval.  Results: There was a statistically significant reduction in both the groups in respect to the TOSS and TNSS scores. However the improvement in the TOSS score in the fluticasone furoate group was more than the mometasone furoate group by 6 weeks (p=0.0009), which continued till the 12 weeks (p=0.045).Conclusions: Fluticasone furoate is more effective than mometasone furoate in managing the ocular and nasal symptoms of allergic rhinitis. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Endoscopic evaluation of bleeding points in epistaxis: a cross sectional

    • Authors: Baneesh A. B.
      Pages: 923 - 926
      Abstract: Background: Epistaxis is one of the most common emergencies that come to casualty department and of which some are difficult to treat. Rigid nasal endoscopy plays a paramount role in managing epistaxis. The present study was done to map bleeding points with regard to its location, to identify the common areas and to discover the hidden areas. Methods: 56 patients with epistaxis were examined using nasal endoscope under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were included in the study.  Results: 18 (32%) patients had bleeding point in right side and 24 (42.8%) patients it was in left side. 51.7% patients had bleeding point located on medial wall of nasal cavity and 19.6% patients had bleeding points on lateral wall of nasal cavity. Conclusions: Nasal endoscopy plays a vital role in management of epistaxis. Most common bleeding point locations are on septum, near middle turbinate area.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Stroboscopy: an evolving tool for voice analysis in vocal cord pathologies

    • Authors: Sneha D. Rajput, Mittal J. Poriya
      Pages: 927 - 931
      Abstract: Background: Benign vocal fold disease, such as vocal polyp, vocal nodule, intracordal cyst or Reinke’s edema is one of the most common causes which deteriorate the voice. Since 1854 when Manuel Garcia first observed the movement of his own vocal cords using a laryngeal mirror and sunlight as the light source, a number of techniques for demonstrating laryngeal anatomy have evolved. Preoperative evaluation of these lesions initially by indirect laryngoscopy or direct rigid laryngoscopy, gave way to the use of transnasal flexible fibreoptic endoscopy in the eighties. The introduction of the video stroboscope into Otorhinolaryngology practice has revolutionized the assessment of vocal cord pathology.Methods: The present study includes a 50 cases of subjects with complain of change of voice coming at department of E.N.T and Head and Neck surgery, at our hospital. A detailed history was taken following which a thorough examination of larynx using appropriate techniques were carried out. Further investigations were done as and when required.  Results: On stroboscopic examination patients were analyzed on four parameters like, symmetry, amplitude, periodicity and mucosal wave. Observations of periodicity and mucosal wave were significantly different in preoperative and post-operative analysis. Stroboscopic evaluation suggested that preoperatively 50% of the patient were having asymmetricity, decreased amplitude, aperiodicity and absent mucosal wave. On postoperative follow-up at 15 days and 2 months interval almost all the patients got all the parameters near normal.Conclusions: It was observed that statistical significant difference in pre and postoperative findings of different parameters of voice evaluated using it. We can draw the probable conclusion that video stroboscope proved to be useful and reliable tool for evaluation of the patients with benign vocal cord pathologies as it reflects the change in the all the parameters of voice postoperatively most accurately and promptly. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Endonasal dacryocystorhinostomy without stents: our experience

    • Authors: Preeti S. Raga, Amrith Laal Waghre
      Pages: 932 - 935
      Abstract: Background: Dacryocystorhinostomy (DCR) for the treatment of nasolacrimal duct obstruction. The aims of the study were to assess the patency rate of endoscopic (ED DCR) using a technique similar to that described by McDonogh and Meiring but without the use of nasolacrimal silicone stents. Methods: Endonasal dacryocysto-rhinostomies (ED DCRs) were performed without the use of silicone stents in 46 patients (20 male, 26 female). These patients were followed up for an average of eight months.  Results: The procedure was successful in 86.95% of cases as measured by patient’s relief of symptoms and endoscopic visualization of a middle meatal ostium draining the lacrimal sac. Conclusions: In our study ED DCR without stents had less complications and also a success rate of 86.95% achieved when compared with DCR with stents.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Rigid bronchoscopy for foreign body removal: an overview

    • Authors: Shashidhar K., Roshna Raj V. Rajan, Nizin Shah, Nikhil Bhat
      Pages: 936 - 938
      Abstract: Background: Foreign body aspiration is a potentially life threatening medical scenario. Immediate diagnosis and intervention can save the many adverse outcomes. The aim of our study was to determine the pattern, presentation and management of foreign body aspiration in our population. Methods: This is a retrospective study carried out in the Department of ENT and Head and Neck Surgery And Surgical Oncology, Karnataka Institute of Medical Sciences, Hubballi comprising of 22 patients with foreign body aspiration admitted to our department from July 2015 to February 2017.All patients with high suspicion of foreign body aspiration were included in our study. All patients underwent rigid bronchoscopy under general anesthesia.  Results: In our study, majority of our patients were in the paediatric age group below the age of three years. History was always accidental inhalation of the foreign body. Areca nut was the most common foreign body removed. All patients who underwent successful foreign body removal following rigid bronchoscopy completely recovered from their ailments. Conclusions: It could be concluded that rigid bronchoscopy is treatment of choice in management of foreign body aspiration especially in pediatric population. The gold standard for the diagnosis and management of this condition is rigid bronchoscopy under general anaesthesia.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Various outcomes of pinna abscess management in our experience

    • Authors: Santhanakrishnan K., Poornima S. Bhat
      Pages: 939 - 942
      Abstract: Background: Pinna perichondritis is a common secondary to trauma due to RTA or high ear piercings. Early intervention with antibiotics can lead to cure without sequelae. Delayed presentation, suboptimal treatment, abscess formation, delays in surgical intervention can cause cartilage loss and cosmetic deformity. This study is conducted to evaluate the various outcomes of surgical intervention of pinna abscess and its predisposing factors in our experience. Methods: A retrospective review was conducted to identify the cause, microbiology, management and outcome of the pinna abscess. Over a period of 2 yrs from September 2014 to September 2016, patients presenting with pinna abscess to the department of ENT, SMVMCH, Pondicherry, who underwent incision and drainage at least once were included in this study. 21 patients were included in the study. Exclusion criteria were post auricular abscess, infected pre auricular sinus.  Results: Among 21 patients, 11 were males and 10 were females. Most common etiology was road traffic accident in 15 patients, followed by high ear piercing 3 patients, and post-surgical in 1 patient.8 patients responded well with initial incision and drainage and IV antibiotics, with no postoperative complications. 2 patients needed second incision and drainage. 11 patients required incision and drainage more than 2 times and change of IV antibiotics. Among 21 cases, 10 were culture positive. The commonest pathogen was Pseudomonas aeruginosa in 9 cases. Staphylococcus aureus in 1 case. 11 patients developed postoperative complications cauliflower deformity in 4 patients, recurrent abscess in 7 patients.Conclusions: Pseudomonas aeruginosa is the most common organism responsible for the pinna abscess caused by trauma (RTA), high ear piercings. Complications like cauliflower deformity and recurrent abscess were noted, which can be reduced by early initiation of antibiotics with surgical intervention.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparison of anterior nasal packing and absence of packing after

    • Authors: Vinnakota Sriprakash
      Pages: 943 - 947
      Abstract: Background: Increased safety in the anesthesia and its techniques as well as the improved newer techniques, better outcome of this surgery have prompted many to undergo cosmetic surgeries such as rhinoplasty. The side effects observed are nasal obstruction, edema of the face, periorbital swelling and ecchymosis, which are of a great concern, and said to be aggravated with the anterior nasal packing. Methods: 100 patients between 18-45 years of age, with nasal trauma were included in the study. Bilateral lateral osteotomies was performed in all patients, with anterior nasal packing done for control group and only external immobilization was done for the study group.  Results: No statistical difference was found between the two groups with regards to age and sex. However, there was a significant difference in severity and duration of periorbital ecchymosis in the different groups. On the 3rd day after the operation, more than one half of the unpacked study group (58.0%) showed ecchymosis of grade 1 or less compared with only 14.0%. in the control group. On the 7th post-operative day however, both sides showed improvement to grade 1 or less in 98.0% and 40.0% of unpacked and packed sides, respectively. Conclusions: Anterior nasal packing post rhinoplasty with lateral osteotomies plays a significant role in the resultant ecchymosis and it should be only used when necessary.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Perceptive analysis of nasal surgery outcomes for headache

    • Authors: Sreenivas C., Sanjeev Kumar Awasthi
      Pages: 948 - 951
      Abstract: Background: Headache is the most common symptom requiring visit to a medical practitioner, sinus headache is one of the sub types of headache. Sinus related headaches are curable by surgical methods with a view to restore the functions of the maxilla-ethmo-turbinal ventilation. In this background we conducted a prospective study to investigate the perceptive relief of symptom of proven rhinosinugenic headache in patients undergoing functional endoscopic sinus surgery with septoplasty.Methods: Prospective study, done at a command hospital, Bangalore, a tertiary PG Teaching Hospital during 2010-2011. Even though 200 patients enrolled for the study, only 98 subjects could be assessed at the end of 1 year duration. A patient centric subjective perceptional questionnaire was given preoperatively and then postoperatively on definitive intervals and the patient’s subjective score was tabulated.  Results: Rhinosinugenic headache is common amongst 36.73% of the population in the age group of 20 to 30 years age group, followed by 25.5% in the 41 to 50 years age group. Gender distribution- 56% of females in the age group of 31 to 50 years are suffering from headache, and 28% of women in the age group of 31 to 40 years. The most common endoscopic findings were bulla ethmoidalis with a prevalence of 37.75%, followed by middle turbinate anomalies of 31.63%.Conclusions: Endoscopy could not pick up any finding in 8.16% of the study group which was picked up by the non-contrast computerized tomography, perceptive analysis– there was an overall improvement of patient centric headache symptom alleviation of 98% after FESS with septoplasty.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Etiology of obstructive sleep apnoea syndrome

    • Authors: Sandesh Priyadarshan, Shrinath D. Kamath P.
      Pages: 952 - 956
      Abstract: Background: The aims of the study were to evaluate the various etiological factors of obstructive sleep apnoea syndrome and to make recommendations based on study findings.Methods: The study group consists of 60 patients who are diagnosed clinically and polysomnographically to have obstructive sleep apnoea syndrome at ENT and Pulmonary Medicine outpatient departments.  Results: Most cases of severe OSA were in age group of 21-40 (47.8%). No significant association was observed between age distribution and severity of OSA (p=0.295). A significant association was observed between obesity and increasing severity of OSA (p<0.05). The mean AHI of patients with mild, moderate and severe OSA was 8.45, 23.31 and 49.07 respectively (p<0.05). Enlarged adenoids, narrow oropharyngeal inlet, bulky tongue, enlarged tonsils and greater neck circumference were significantly associated with OSA (p<0.05). No significant association between DNS, ITH, concha bullosa and enlarged adenoids with OSA (p>0.05).Conclusions: Certain naso-oro-pharyngeal parameters were found to be significantly associated with obstructive sleep apnoea syndrome viz. enlarged adenoids, bulky tongue, greater neck circumference and narrow oropharyngeal inlet. Patients with these features should further be investigated with CPAP titration polysomnography and surgical intervention. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Study the effect of osteopathic manipulation treatment in globus
           pharyngeus patients

    • Authors: Nitish Baisakhiya, Manu Goyal, Gurchand Singh, Sagar Chandra
      Pages: 957 - 961
      Abstract: Background: This study evaluates the outcome of osteopathic manipulation in the patients with globus pharyngeus.Methods: The study comprised of 50 patients with globus pharyngeus. All cases were provided major body diaphragms release namely pelvic diaphragm, abdominal diaphragm, thoracic outlet release, hyoid release, gastroesophageal junction release and sphenoid basilar junction generalized release in some selected cases as per their symptoms. Patients were treated 2 times in a week for 3 weeks.  Results: Results were analyzed on the basis of patient’s satisfaction and improvement in the symptoms on regular basis after 2 wks. Visual analogue score (VAS) and clinical assessment were used to see the quantum of satisfaction and overall symptoms. The mean VAS score of patients receiving OMT (MFR) with PPI was 6.23±0.43 and patient who required psychotherapy along with OMT (MFR) had the VAS score of 3.78±0.17 (p<0.05).Conclusions: The patients required multidisciplinary approach hyoid bone release and other osteopathic manipulations, anti-reflux and antipsychotic treatment. The patients having psychological symptoms requiring antipsychotic drugs were found to be least respondent to the treatment. Patients having associated GERD showed a good response to the treatment and their dependency on drugs decreased following the OMT. The best response was seen in patients having no associated ailment and received OMT (MFR). 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A prospective study to evaluate the etiologies and parameters of voice
           assessment in patients of vocal cord paralysis

    • Authors: Anagha A. Joshi, Vijaykumar Singh, Sana Zehra N. Rajani
      Pages: 962 - 967
      Abstract: Background: Evaluation of voice disorders are performed using multiple approaches but there is no single standard method. Our study compared the various voice assessment measures and their clinical relevance for unilateral vocal cord palsy (uVCP).Methods: 30 patients of uVCP were assessed and followed up on day 15, 30 and 90 of diagnosis. At each visit, perceptual analysis of voice, grade (G), rigid 700 Hopkins laryngoscopy to measure the phonatory gap (PG), maximum phonation time (MPT), and voice handicap index (VHI) were noted.  Results: The results were analysed in two ways, one on the basis of improvement in VHI and the other on the basis of PG. When two groups (‘improved group 1’ and ‘unimproved group 1’) were formed and compared on the basis of VHI; MPT, Grade and ‘change in PG’ of the improved group showed a significant difference as compared to the unimproved group. Whereas when two groups (‘improved group 2’ and ‘unimproved group 2’) were formed and compared on the basis of improvement in PG, none of the parameters of the improved group showed a significant difference as compared to the unimproved group.Conclusions: All parameters correlate well with VHI than with PG, hence VHI alone can be sufficient to assess the improvement in voice. Although rigid laryngoscopy is essential initially for diagnosis, it need not be necessary to for further evaluation for improvement in voice.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal

    • Authors: Deepak Janardhan, Bipin T. Varghese, Elizabeth Mathew Iype, Shaji Thomas
      Pages: 968 - 971
      Abstract: Background: Total laryngectomy in laryngohypopharyngeal cancers, both in primary setting and salvage scenario, include variable amounts of thyroid resection. Although considerable proportion of these cases undergo total thyroidectomy, with an intention of wider surgical clearance, histopathological examination for thyroid infiltration, very often indicate that such resections are generally out of proportion to the actual oncological requirement.Methods: Forty three patients undergoing total laryngectomy with no prior thyroid dysfunction, from April 2014 to 2016, at our centre, were prospectively studied for post treatment, thyroid function with tests done at 6th month. Overt and occult hypothyroidism was correlated with extent of thyroid preserved intraoperatively.  Results: Of 43 patients studied, 82% had extralaryngeal spread, and 16% of them showed thyroid gland infiltration. Only 7% were patholog1ically correlated for gland infiltration. Among those who had hemithyroidectomy, clinical hypothyroidism was seen in 20% primary and 85% salvage cases by 6th month of post treatment period.Conclusions: In clinicoradiologically favourable scenarios, thyroid preservation attempt helps to augment the neopharynx closure line and to preserve the parathyroids. Anatomical preservation however doesnot guarantee thyroid function, which needs regular follow up to avoid post-operative complications and better QOL.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparative study between diagnostic nasal endoscopy and computed
           tomography of PNS in sino nasal diseases

    • Authors: Mallikarjun S. Tegnoor, Joseph Williams George, Williams George, Ramchandra Joshi
      Pages: 972 - 978
      Abstract: Background: The objective of this study is to compare the tomographic findings to the nasal endoscopy findings in patients with chronic sino-nasal diseases. This study aims to compare CT scan and DNE in sino-nasal diseases.Methods: 50 Patients attending ENT, OPD, BTGH with any sino-nasal complaints lasting for more than 4 weeks and not responding to medical line of management. Patients are selected by random sampling method. Patients were evaluated with CT scan and DNE.Results: The most common co-morbidity found among the patients is chronic rhino sinusitis in 31 cases (62%). Middle meatal purulent secretions are the most obvious finding in DNE evaluation seen in 31 (62%) cases. Anterior ethmoidal sinus haziness is seen in 37 (74%) cases on CT scan with majority of cases showing associated sinus involvement.Conclusions: Thereby indicating that in all patients with sino nasal diseases both CT scan and DNE has to be done, to know the exact pathology and to plan for further management. Both CT scan and DNE are complimentary to each other.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Bacteriology and antibiotics treatment of maxillary sinusitis: a
           prospective study

    • Authors: Santosh Malashetti, Abhay Havle, Rajesh Karembelkar
      Pages: 979 - 985
      Abstract: Background: Sinusitis is one of the commonest causes of patients visit to the otorhinolaryngologist, around one in five cases. The prevalence of sinusitis (146/1000) has been reported. Estimates suggest that clinical condition of sinusitis is more widespread than arthritis and/or hypertension. Sinusitis significantly impacts quality of life, even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure. Sinusitis is the fifth most common medical diagnosis for which antibiotics are prescribed. Sinusitis is usually managed with a 10 days complete course of appropriate sensitive antibiotics. To achieve this goal, there should be some diagnostic modalities which guide towards exact diagnosis as well as safe intervention and cost effective. Over past decade, x-ray paranasal sinuses (Water’s view) and nasal endoscopy have been used successfully as diagnostic modalities in sinus disease.Methods: 100 patients presenting with complaints of sinusitis to the ENT OPD KIMSDU Karad, Maharashtra India were selected randomly (more than 12 yrs of age). All of them were examined clinically and subjected to X -ray PNS (Water’s view) and diagnostic nasal endoscopy [DNE]. Antral lavage was done for all the patients and returning fluid sent for culture and sensitivity. Results were evaluated by statistical analysis using chi square test and evaluating p value tabulated and compared. Appropriate antibiotics were advised orally for 10 days, on the basis of culture reports, such as Amoxcillin-Clavulinate 625 mg BD, Cefpodoxime proxetil 200 mg BD, Levofloxacin 500 mg OD, Ciprofloxacin-Tinidazole (500:600 mg) BD.Results: Majority of the patients were in the age group of 20-29 years (46%) and females (53%). Most common organisms causing maxillary sinusitis was- S.aureus (coagulase+29%). It was found that Amoxicillin-Clavulinate has highest efficacy as compared to other antibiotics.Conclusions: According to our study, most common organisms causing acute maxillary sinusitis in this study are S aureus (coagulase+), S pnemoniae and Enterobacteriacae. Most common organisms isolated are anaerobic Peptostreptococcus, coagulase positive S. aureus and fusobacterium in chronic rhinosinusitis. Efficacy of Amoxicillin-Clavulinic acid was 96% clinically, 94% based on results on DNE findings and 87% by radiological success rate which is statistical more significant than other class of antibiotics. So amoxicillin clavulinic acid can be considered as first line of drug for treating bacterial rhinosinusitis. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Insulin resistance and affecting factors in patients with obstructive
           sleep apnea syndrome

    • Authors: Hatice Beyazal Polat, Metin Çeliker, Songül Özyurt, Suat Terzi, Abdülkadir Özgür
      Pages: 986 - 989
      Abstract: Background: Metabolic syndrome and insulin resistance are common in patients with obstructive sleep apnea syndrome (OSAS) independently of obesity. This study aims to examine and evaluate the insulin resistance and the factors affecting the insulin resistance in patients with OSAS.Methods: Patients admitted to the sleep disorders clinic of our hospital with snoring complaints and diagnosed with OSAS in the last 6 months were included to the study. Insulin resistance was calculated by the Homa-IR formula. >2.7 was considered insulin resistance.  Results: The mean Homa-IR value was 3.86±4.69 and 42 (49.4%) patients were found to have insulin resistance. Mean insulin resistance was 2.68±2.2 in normal weight patients, 2.30±1.41 in overweight patients, 3.96±1.83 in obese patients, and 8.61±12.13 in morbid obese patients. The mean apnea hypopnea index of the patients was 22.95±15.20; 30 (35.2%) were with mild, 26 (30.6%) were with moderate and 29 (34.1%) were with severe OSAS. Insulin resistance was 2.35±1.36 in patients with mild AHI; 3.09±1.30 in patients with moderate AHI, and 6.11±7.35 in severe cases. In our study, the most significant relationship was found to be between insulin resistance in OSAS patients with insulin resistance and BMI and AHI.Conclusions: Insulin resistance is common in patients with OSAS independently of obesity. In our study, BMI and AHI were found to be the most important factors associated with insulin resistance in patients with OSAS.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Septoplasty techniques- conventional versus endoscopic: our experience

    • Authors: Renu Rajguru, Inderdeep Singh, J. R. Galagali, Anubhav Singh
      Pages: 990 - 996
      Abstract: Background: Deviated nasal septum is one of the most common disorders in human beings, which may lead to symptoms of nasal obstruction, headache, epistaxis, hyposmia, and post nasal drip. DNS correction may also be required to gain access during intranasal procedures like endoscopic sinus surgery, endoscopic dacryocystor-hinostomy and skull base surgery. The technique of septoplasty has evolved over the decades with a tendency towards more conservative and precise surgery. Over the last few decades endoscopic septoplasty has become increasingly popular.Methods: It was a cross-sectional comparative study done to compare the efficacy of endoscopic septoplasty with conventional septoplasty, conducted at a tertiary care centre over a period of 3 years. Records of 100 patients of nose and PNS disorders with DNS who were operated either by conventional or by endoscopic technique were studied. The patients were studied for the improvement in their symptoms, anatomical correction and intra-operative/post-operative complications.  Results: Endoscopic septoplasty group patients showed better symptomatic relief, lesser incidence of residual anterior /posterior deviation and persistent spur and less complications as compared to the conventional septoplasty group.Conclusions: In our study we found more clientele satisfaction and lesser rate of complications in endoscopic septoplasty group. We recommend all ENT specialists to be trained in nasal endoscopic septoplasty technique as it offers many advantages such as more precision in post nasal spurs with less flap tears, it can be tailor made according to the disease and can be combined with various endoscopic surgeries.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A comparative study between fat myringoplasty and temporalis fascia
           tympanoplasty in moderate to large central perforation of pars tensa of
           tympanic membrane

    • Authors: Kirti P. Ambani, Rachana W. Gangwani, Bhavya B. M., Sanket D. Vakharia, Ashish U. Katarkar
      Pages: 997 - 1001
      Abstract: Background: To compare the efficacy between fat graft (FG) and temporalis fascia (TF) graft in tympanic membrane perforations larger than 4mm size or involvement of >25% of tympanic membrane.Methods: This prospective study was carried out during December 2015 to January 2016, for a period of 13months at our Otolaryngology Department. All study patients, who fit into inclusion and exclusion criteria, were divided into two groups according to the type of graft material taken. In group- 1temporalis fascia (TF) graft was taken while in group- 2 fat graft (FG) was taken. An evaluation of hearing was done with full Audiometric and Eustaschian tube function testing. All laboratory preoperative testing was done. Postoperative follow up was done at 2nd, 3rd and 5th month’s period and sos, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded and compared with preoperative PTA records in both groups.  Results: In TF group total 24 (80%) patients had graft uptake, 4 (13.3%) patients had residual perforation and 2 (6.6%) patients had graft failure due to postoperative infection. In FG group total 16 (53.3%) patients had graft uptake, 6 (20%) patients had graft medialised and necrosed, 6 (20%) patients had residual perforation and 2 (6.6%) patient had graft rejection due to postoperative infection. Graft uptake rate in group 1 was 80% while in group 2 was 53.3%. Mean preoperative ABG in TF group was 25±17 dB and mean postoperative ABG was 10±02 dB, in fat graft technique mean preoperative ABG was 25±13 dB and mean postoperative ABG was 16±15 dB. Fat graft technique is simple, quick and minimally invasive. It doesn’t require middle ear manipulation.Conclusions: There is no ideal material for tympanic membrane repair but for moderate to large perforation temporalis fascia graft is better than fat graft in terms of healing and hearing outcomes but considering morbidity fat gives less morbidity. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A study on presentation, etiology, complications and management of deep
           neck space infections: our experience

    • Authors: Pradip Khokle, Vaibhav J. Lahane, Swati Mishra, Moinnudin Choudhary
      Pages: 1002 - 1009
      Abstract: Background: To analyze our experience in presentation, etiology, complications and difficulties encountered in diagnosis and management of deep neck space infections.Methods: 52 cases of deep neck space infections were analyzed within the period of November 2013 to November 2015 in ENT OPD at GMC Latur. Patients with airway compromise or in failures were managed with intubation or tracheostomy. All patients were investigated with detail history, hematological and radiological investigations like X- Ray, USG or CT scan. Although all patients were treated with intravenous antibiotics, surgical drainage was the definitive management.  Results: Study includes 29 males and 23 females. Neck pain was most common presentation in 90.38% with airway compromise being most common complication. Submandibular (34.61%) and peritonsillar (21%) space were commonly involved with odontogenic and upper airway infections being leading causes. Diabetes was common comorbidity found among patients. Staphylococcus aureus being common isolate (Klebsiella in diabetics). Surgical drainage with antibiotics as per culture sensitivity was treatment modality of choice.Conclusions: Early diagnosis and appropriate management is key for better outcome. Odontogenic etiology being most common correlates well with poor oral hygiene and tobacco chewing. Surgical drainage and antibiotics are the treatment modalities. Complications and associated comorbidities affect the course of DNSI and hence require appropriate management. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • An observational study comparing the effect of sphenopalatine artery block
           on bleeding in endoscopic sinus surgery

    • Authors: M. N. Shankar, V. Saravana Selvan, Nigil Sreedharan
      Pages: 1010 - 1014
      Abstract: Background: The use of the sphenopalatine artery block to reduce bleeding during FESS, has been a debatable issue. This cross sectional observational study aims to study whether sphenopalatine artery block has any significant effect on bleeding. Methods: 55 patients coming to the ENT department of Stanley Medical College from 2015–2016 were included in this study. All patients had bilateral nasal sinus disease and endoscopic sinus surgery was performed on both sides. 20 minutes prior to surgery one side was chosen randomly and sphenopalatine artery block was administered via the greater palatine canal approach. A mixture of lignocaine (2%) and adrenaline (1:80000) was used for infiltration. The surgery was done in an alternating fashion where the surgeon would operate for 15 minutes on one side and then moved onto the other side. The field was graded using the Wormald Grading at 30 minute intervals. The results were tabulated and the Wilcoxon Signed Rank Test was done at each time interval to see if there was a statistically significant difference in the grades of bleeding on both sides at each time interval. SPSS version 22.0 was used to analyse the data. Significance level was fixed as 5% (α=0.05).  Results: It was found that for each time interval up to 120 minutes there was a significant decrease in the bleeding on the blocked side. However after 120 minutes the bleeding on both sides appeared to be same. Conclusions: Sphenopalatine artery block given prior to surgery will be effective in reducing bleeding in FESS for the first 2 hours after which the effect of the block wears away.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinico-pathological spectrum of sinonasal masses: a tertiary care
           hospital experience

    • Authors: Abhishek Maheshwari, Anshul Bansal
      Pages: 1015 - 1019
      Abstract: Background: Sinonasal masses (SNM) are a fairly common clinical entity that occurs amongst patients of all age groups. There symptoms and signs frequently overlap, hence a diagnostic dilemma exists. A correct diagnosis is prudent for instituting correct treatment and expecting recovery. The purpose of this retrospective analysis was to decipher and study the various pathologies that present as sinonasal masses.Methods: A retrospective analysis done on 80 patients of SNM who presented to the Department of ENT, Subharti Medical College and Hospital, Meerut from May 2016 to April 2017. Their biodata, clinical profile and histolopathological diagnosis were analyzed.  Results: SNM were male predominant and were non-neoplastic in 53 cases (66.25%). Nasal obstruction was the most common presenting feature (71 cases, 88.75%). Nasal polyps are the most commonly encountered SNM. Non-neoplastic SNM were common in the age group of 11 to 40 years. Benign SNM were common during the 2nd to 4th decade of life, while malignant SNM were common from 5th decade onwards.Conclusions: SNM constitute a very wide spectrum of differential diagnoses. They have a male predominance and majority are non-neoplastic. Nasal polyps are the most commonly encountered SNM, seen during 2nd to 4th decade of life, while squamous cell carcinoma is the most commonly encounterd malignancy, generally from 5th decade onwards. Surgery is the treatment of choice.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Hadad-Bassagasteguy flap in reconstruction of skull base defects after
           endonasal skull base surgery

    • Authors: Chandra Veer Singh, Nishit J. Shah
      Pages: 1020 - 1026
      Abstract: Background: To study the clinical outcomes of Hadad-Bassagasteguy flap (HBF) in endonasal reconstruction of anterior skull base defects. Methods: We prospectively analyzed the demographic data & the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding.  Results: Most of the study subjects were between21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%). Conclusions: Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with high-flow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A study on clinical profile of non otogenic otalgia

    • Authors: Valli Rajasekaran, Sharath Kumar B. V.
      Pages: 1027 - 1030
      Abstract: Background: Ear pain can be because of pathologies in the ear or in the surrounding head and neck region. This is because of rich innervations of the ear. Sometimes it poses a diagnostic challenge.Methods: A cross sectional study was conducted in our institute where patients with ear pain were evaluated. Those with non otogenic causes were included in the study. 59 patients were identified and studied for the underlying cause. The sociodemographic profiles of the patients with varying etiologies were studied.  Results: The most common cause for referred pain was temporomandibular joint dysfunction. This was more common in 15-45 years and in older age group cervical spondylosis was more common. There was no significant sex predominance.Conclusions: Careful detailed evaluation of the patient should be done to identify the exact underlying cause and treat effectively.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A study on paediatric stridor causes and management: case series

    • Authors: D. K. Selvam, V. J. Vikram, M Saktheeswaran, Mohammed Irfad M P
      Pages: 1031 - 1035
      Abstract: Background: Stridor is one of the life threatening symptoms presenting to the Emergency Department. Stridor is a sign of airway obstruction, so it demands immediate attention and thorough evaluation to uncover the precise underlying cause. This study on paediatric stridor is to find the causes of stridor in paediatric age group are to identify the cause to initiate treatment of stridor, suggest an approach to evaluate and manage the underlying cause.Methods: Retrospective study of series 515 cases in paediatric age group, below 12 years of age presenting with respiratory distress to the Emergency department/ENT department. The primary management was to maintain the airway in all cases. Intravenous line established intravenous fluid/antibiotics /steroids/racemic adrenaline, followed by history of the respiratory distress from the parents/ caretakers. Then according to the provisional diagnosis evaluation is done by radiological investigation/ endoscopy.  Results: Laryngomalacia was the most common cause of infant stridor in less than one year of age in 348 cases, while Foreign body aspiration is the most common cause of stridor in age group one to 12 years in 122 cases. 358 cases (69%) were treated conservatively and cause related management was done in 157 (31%). Endoscopy and imaging offers the best methods in evaluating and treatment of pediatric stridor.Conclusions:The management of stridor in pediatric age group is a team work of ENT surgeons, Pediatrician, Pediatric surgeons, anaesthetist. The airway maintenance is the main management followed by ENT examination, evaluation by imaging, endoscopy and treatment of the cause. We follow the airway management algorithm in order to evaluate the child for diagnosis of the cause for treatment and successful outcomes of stridulous pediatric patients.  
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparative study of type 1 tympanoplasty with and without gelfoam in the
           middle ear

    • Authors: Nabeel Malick, Raveendra P. Gadag, Vidyashree K. M., Shruthi Puthukulangara
      Pages: 1036 - 1041
      Abstract: Background: Chronic suppurative otitis media is a widespread disease with a significant cause of morbidity with a greater burden in the poor communities of the developing countries for which tympanoplasty is frequently undertaken. Gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. This provides the added advantage of facilitating middle ear ventilation through the Eustachian tube. The objectives of the study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gelfoam in the middle ear and without gelfoam in the middle ear and to compare and assess results for complicationsMethods: This was a randomised control trial done for a period of one year conducted in the department of otorhinolaryngology and head and neck surgery, Karnataka Institute of Medical Sciences, Hubballi which is a tertiary referral hospital. 30 patients underwent type 1 tympanoplasty without gelfoam in the middle ear and 31 patients underwent type 1 tympanoplasty with gelfoam in the middle ear. Post-operative follow up was done to look for graft uptake, hearing assessment by pure tone audiometry and impedance audiometry was done 90 days post-operatively.  Results: Graft uptake was 80% in type 1 tympanoplasty without gelfoam in the middle ear and 80.6% with gelfoam in the middle ear. Both types of surgeries had significant hearing improvement, and complications like retraction and residual perforation were also comparable. Ad type of impedance curve is most common post operatively.Conclusions: Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Drug utilization pattern in ENT OPD of government tertiary care teaching
           hospital in Raigarh

    • Authors: Kishore Kumar Y., Chakrapani Cheekavolu, G. Obulesu
      Pages: 1042 - 1045
      Abstract: Background: The prospective, observational study was designed to assess the prescribing pattern of drug usage in ENT outpatient department in various diseases conditions.Methods: Medication utilization Form has been designed based on a WHO format. The patient’s details including patient particulars, diagnosis, investigations, drug details and information regarding the indication for prescribing agents.  Results: Total 200 prescriptions were analysed, 70% were males and 30 % were females, respectively. The most common disease reported was CSOM in 31 (15.5 %) patients followed by otitis externa 25 (12.5%), pharyngitis 21 (10.5%), URTI patients 20 (10.0%). Antibiotics used were: amoxicillin-clavulanate 200 (57.3%), cefixime 37 (10.6%), levofloxacin 34 (9.74%), cefixime clavulanate 30 (8.59%), cefuroxime 13 (3.72%). The most commonly used NSAID are diclofenac and paracetamol.Conclusions: Prescribing pattern of usage of antibiotics are more compared to other drugs, amoxicillin with clavulanic acid are most commonly prescribed antibiotics in various ENT diseases, usage of brand name are higher than the generic name. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A comparative study of endoscopic versus conventional septoplasty: an
           analysis of 50 cases

    • Authors: Sagar Chandra, Nitish Baisakhiya
      Pages: 1046 - 1051
      Abstract: Background: Nasal obstruction is the most common complaint in ENT practice. Surgical correction of deviated nasal septum has been performed by a variety of techniques of which sub mucous resection and Septoplasty procedures of surgical correction of nasal septum play a prime role in management of patients of nasal obstruction. Nasal endoscope is very useful tool to visualize posterior part of septum and do the surgery more precisely and with less complication as compare to conventional method. The objectives of the study were to compare the outcomes of conventional and endoscopic septoplasty, to evaluate the advantages, disadvantages and complications of both endoscopic and conventional septoplastyMethods: 50 cases (between (Oct. 2014 - March 2016) of deviated nasal septum selected in this prospective study and they were randomly divided equally in 2 groups for endoscopic (A) and conventional (B) septoplasty respectively.  Results: The study included 50 cases. Majority of patients in this study were males 84% (n=42) and 16% (n=18) were female. 46% (n=23) patients had DNS to right side and 54% (n=27) patients had left side, anterior deviation (48%). C and S shaped deviations (14%). Spur was present in 22% (n=11) of cases and 10% (n=5) patients presented with thickening. After completing 2 months of follow up 92% (n=23) of group A and 88% (n=22) of group B were relieved from nasal discharge, while nasal obstruction was absent in 96% (n=24) patients of group A and 80% (n= 20) of group B. 4% cases (n=1) in endoscopic septoplasty was having persistent deviated nasal septum and 16% (n=4) patients of conventional septoplasty belong to this group.Conclusions: Endoscopic septoplasty has an obvious edge over the conventional approach due to better illumination which enables to identify the pathology accurately, excise the deviated part of septum precisely and realignment of the cartilage for best results.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Comparative evaluation of surgical and audiological outcomes in patients
           of chronic suppurative otitis media with dry ear treated by myringoplasty
           with or without simple mastoidectomy

    • Authors: Amanjot Kaur, Vinod M.K., Jagdeepak Singh, Baldev Singh, Priyanka ., Simranjit Kaur
      Pages: 1052 - 1055
      Abstract: Background: The study was conducted to compare and evaluate surgical and audiological outcomes in patients of chronic suppurative otitis media with dry ear treated by myringoplasty with or without simple mastoidectomy. Prospective, open label, randomized, comparative  study, conducted  in the Department of ENT, Ram Lal Eye and ENT hospital, Government Medical College Amritsar, Punjab, India.Methods: This study comprised of 40 patients aged between 15 to 50 years having CSOM (safe type) with dry ears for the last 3 months. Patients were randomly divided into Group A treated with myringoplasty alone and Group B with standard simple mastoidectomy along with myringoplasty using temporalis fascia graft by underlay technique. Patients also subjected to routine hematological, biochemical, radiological and audiological investigation. The audiological comparison done before and after surgery.  Results: It was observed that graft uptake rate was better in group B. The average gain in air conduction threshold was more in patients who had undergone myringoplasty along with simple mastoidectomy. However this was not statistically significant. There was no significant improvement observed in the AB Gap in our patients who underwent myringoplasty or simple mastoidectomy along with myringoplasty.Conclusions: Hypocellularity of the mastoid process has a strong correlation with the tubotympanic type of CSOM. Addition of mastoidectomy to simple myringoplasty has a very little beneficial effect on the postoperative hearing gain and graft uptake as it showed no much statistical significance.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Pathar dye (paraphenyldiamine) poisoning: our experience of this lethal
           emerging health problem in a tertiary care centre

    • Authors: Shivani Nautiyal, Shashwat Tiwari, Kumar Ashutosh
      Pages: 1056 - 1059
      Abstract: Background: The aim of this case series study is to share our experiences regarding paraphenylenediamine (PPD) poisoning, its otolaryngological clinical presentation ,outcomes and need of tracheostomy in patients of hair dye poisoning at GSVM Medical College, Kanpur, U.P.Methods: This prospective study was carried out on 165 patients who presented in GSVM medical college Kanpur in period of December 2012 till December 2014. Data including demographic features (age, sex, marital status, socio-economic status), clinical features, laboratory findings, mode of intoxication (accidental or suicide) were collected and recorded.  Results: A majority of the patients were young females (21-30 years) and belonged to a low socioeconomic class. The main cause was intentional suicidal ingestion. Cervicofacial edema, stridor, hoarseness of voice and pain in throat were initial symptoms. Tracheostomy was needed in 115 (69.69%) patients. Mortality of 21 (12.72%) patients was observeds.Conclusions: It is a major emerging health problem with high mortality. It is a medical emergency and early intervention is needed to save patient's life. It is imperative to raise public awareness of the potential toxicity of the dye as well as to educate physicians about the need for aggressive and early treatment. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A comprehensive study of oesophageal foreign bodies

    • Authors: Carnegie J. A. De Sa, H. C. Goel
      Pages: 1060 - 1063
      Abstract: Background: Various foreign bodies of respiratory and food passage are enlisted. Nature of foreign bodies their presentation, management and complications are discussed.Methods: 200 consecutive cases of foreign bodies in the oesophagus which were admitted in a tertiary care hospital are included in the study.  Results: Most of the ingested foreign bodies managed with oesophagoscopy except three cases of denture.Conclusions: Children below 10 years of age are the commonest candidates prone to ingest foreign bodies. The coins are the most frequently ingested foreign bodies. Though most of the foreign bodies can be managed safely with oesophagoscopy, yet one has to be careful while removing sharp foreign bodies like dentures etc. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Alterations of serum lipid profile in oral submucous fibrosis

    • Authors: K. Mallikarjuna Swamy, Arati Ganiger
      Pages: 1064 - 1067
      Abstract: Background: Oral cancer is one of the most common form of malignancies in India. In many cases it develops at the site of premalignant lesion. Of all oral premalignant conditions, oral submucous fibrosis (OSMF) is of greater concern because of its disabling nature and relative greater chances of malignant transformation. This study is aimed to evaluate the serum lipid profile in OSMF patients as the change in lipid levels may have a diagnostic and prognostic role in the potentially malignant lesions. The present study aimed to evaluate the alteration in serum lipid profile in OSMF and to compare them with healthy controls and to correlate the relationship between pathogenesis of OSMF and lipid profile.Methods: It is a case control study. The study included 50 diagnosed cases of OSMF and 50 matched healthy controls. Fasting venous blood of 3 ml was collected in both cases and controls and serum was separate. Fasting serum lipid profile including total cholesterol (TC), very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL) and triglycerides (TG) were measured using automatic analyser. Statistical analysis was done using student 't' test .Pearson's correlation  was performed to establish the relationship between study variables.  Results: It was observed that there was statistically significant decrease in serum total cholesterol, TG, LDL, VLDL and HDL observed in patients with OSMF  as compared to the control group (p<0.005).Conclusions: The low lipid levels associated with OSMF indicates that there is inverse relationship between oral cancer and serum lipid profile. Decrease in the lipid levels may be considered as a valuable biochemical marker in the early diagnosis and prognosis of oral malignancy. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Compare the role of positron emission tomography scan to conventional
           imaging in the evaluation of advanced head and neck cancers

    • Authors: Angshuman Dutta, B. G. Chaitra, Harkirat Singh
      Pages: 1068 - 1071
      Abstract: Background: Advanced stages of head and neck cancers need careful evaluation by imaging to rule out multiple nodal and distant metastasis which might influence management and prognosis. The aim of the study was to compare the role of PETCT scan to MRI in the initial evaluation in advanced cancers of head and neck.Methods: The study included 46 patients having advanced stages of head and neck squamous cancers. The patients underwent clinical examination, endoscopy, an initial CT/MRI of the disease site and conventional metastatic workup with an X-ray Chest and USG abdomen. The patients then underwent PET/CT. Tumor restaging was done after the PETCT and the results of CT/ MRI to PETCT were compared.  Results: There was upstaging of disease in patients with identification of multiple/ bilateral nodes and distant metastasis following PETCT.Conclusions:PETCT scan has an impact on the initial upstaging staging of disease compared to conventional imaging.  
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Versatility of the submental island flap in head and reconstruction

    • Authors: Mahendra I. Katre, Prashant Keche, Arvind Gaikwad, Sunil Deshmukh
      Pages: 1072 - 1076
      Abstract: Background: Head neck cancer is major cause of morbidity and mortality worldwide. India has one of the highest incidences of oral cancer and accounts for about 30% of all new cases annually. Ablative surgery is main stay of treatment which is followed by reconstructive surgery. Microvascular surgery revolutionized onco-reconstruction which requires great expertise even in tertiary cancer centre and it is not possible many times due to long waiting list for it or patient condition. Here there is role locoregional pedicled flap which mitigate this problem to great extent to achieve acceptable functional and aesthetic outcome. One such flap worth to keep in surgeon armamentarium is submental island flap. Submental artery island flap (SIF) is an axial fasciocutaneous flap that includes skin, subcutaneous tissue, platysma, and fat and is pedicled on the submental artery and veins.Methods: This study conducted in our institute a tertiary level cancer hospital. This is retrospective study. Data extracted from department database between periods February 2015 to May 2017. It includes 12 patients diagnosed with different sub site oral cancer, operated in department of head neck oncology for oral cancer and reconstruction fallowing ablative surgery done by submental island flap by ablative surgeon.  Results: Submental island flaps are comparable in their outcome with radial forearm free flap. They carry a good color match with facial tissue. It is thin and has a reliable vascular morphology.Conclusions: When combined with the reported experience of other surgeons, our preliminary experience shows that the SIF is an excellent alternative in the reconstruction of head and neck defects because of its reliability, versatility, and relative ease of application. Neck dissection can plan as an adjunctive procedure to the SIF with certain limitation.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Primary and secondary atrophic rhinitis: a microbiological and
           histopathological study

    • Authors: Parameshwar Keshanagari, Rhesa Noel
      Pages: 1077 - 1080
      Abstract: Background: Atrophic rhinitis is a distressing chronic nasal pathology characterized by progressive nasal mucosal atrophy, formation of thick crusts and a distinct foul odor. The etiology of this condition is still controvertible. The present study was undertaken to evaluate the microbiological flora and histopathological changes in primary and secondary atrophic rhinitis patients.Methods: A total 50 atrophic rhinitis patients (15 males & 35 females) were considered, all patients were undergone for complete haemogram, microbiological examination of nasal pus and histopathological examination for biopsied material.  Results: A total 82% patients were shown primary atrophic rhinitis and 18% cases were secondary atrophic rhinitis. Pseudomonas aeruginosa was commonly isolated bacteria in 72%, followed by Staphylococcus aureus (12%) and other bacteria were E. coli (8%) and Proteus mirabilus (6%) and sterile swab in 2% cases. Squamous metaplasia was found in 78% cases, while transitional metaplasia in 16% cases. The incidence of dilated blood vessels, endarteritis, and periarteritis in lamina propria is 44%, 30% and 16% respectively.Conclusions: Pseudomonas aeruginosa was most commonly isolated bacteria. The most important pathological change is squamous cell metaplasia in atrophic rhinitis patients.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Cochlear implant in patients with incomplete partition type II: surgical

    • Authors: Biram Singh Takhellambam, Nithya Venkataramani, Kiran Natarajan, Umalakshmi Lairellakpam, Abha Kumari, Senthil Vadivu Arumugam, Mohan Kameswaran
      Pages: 1081 - 1086
      Abstract: Background: This study presents our experience on surgical aspects, complications and outcome of cochlear implants in incomplete partition type II patients.Methods: 7 children in the age group of 1 to 5 years with incomplete partition type II, 5 females and 2 males were studied retrospectively from the database of tertiary care centre from February 2015 to December 2016.  Results: 5 patients had conventional transmastoid facial recess approach of which one patient had removal of incudal buttress, incus and stapes suprastructure to facilitate middle turn cochleostomy. 2 patients had subtotal petrosectomy. Complete insertion of electrode was achieved in all patients; by middle turn cochleostomy in 1 patient, cochleostomy in another patient, extended round window in 3 patients and round window in 2 patients. Med-el Synchrony + Form 19 were used in all patients and complete insertion was achieved in all. 4 patients had CSF leak which was sealed with soft tissue. One patient had device failure. 5 children show improvement in CAP and SIR score. One had device failure and was subsequently explanted and re-implanted.Conclusions: Cochlear implantation in patients with incomplete partition type II is challenging and thorough knowledge of anatomy is essential. One must be competent enough to expedite different surgical approaches and manage the associated complications. Prior counselling for guarded outcome and eventualities are necessary in such patients.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Clinico-pathological and radiological assessment of benign nasal masses

    • Authors: Akash Sharma, L. N. Garg, Nitish Baisakhiya
      Pages: 1087 - 1094
      Abstract: Background: Sinonasal masses are uni or bilateral with variable and with multiple etiological factors. Benign masses are common in comparison to malignant in this region. Some of the benign masses e.g. juvenile angiofibroma and inverted papilloma cause local bony destruction. Preoperative radiological assessment is desirable for proper surgical Management. The purpose of the study was to assess the clinical and radiological findings of sinonasal masses and the correlation of the clinical and radiological findings with the histopathology.Methods: This prospective study was carried out on 50 cases if intra nasal masses. After clinical examination, these patients were subjected to radiology. The parameters assessed were the origin, extension, involvement of adjacent structure. Subsequently, all the cases were subjected to surgery i.e. polypectomy, medial maxillectomy, excision with the help of nasal endoscope. Thereafter, the histopathological findings were correlated with clinical and radiological findings.  Results: Total 50 cases of intra nasal benign masses were included in the study. Among them 36 (72%) cases were of nasal polyps, out of which 29 (80.5%) were inflammatory polyps and 7 (19.4%) were allergic polyps. Among inflammatory polyps, 23 (79.3%) were males and 6 (20.69%) were females. Among allergic polyps 4 (57.14%) were males and 3 (42.85%) were females. The other findings were 5 (10%) cases of angiofibroma, 5 (10%) cases on inverted papilloma, 3 (6%) cases of haemangioma and 1 (2%) cases of chondrosarcoma.Conclusions: Considering the result obtained, the most common sinonasal lesions were inflammatory polyps. Others in order in order of frequency were allergic polyp, angiofibroma, inverted papilloma, haemangioma and chondrosarcoma.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Diagnosis and management of laryngeal fracture: a case report

    • Authors: Hicham Attifi, Ayman Elfarouki, Karim Nadour, Mounir Hmidi, Nabil Touihem, Ali Elboukhari, Brahim Zainoun
      Pages: 1095 - 1098
      Abstract: Laryngeal fracture is a rare and potentially fatal traumatic injury. Because of the rarity of this type of injury, many laryngeal fractures are often undiagnosed or poorly managed, leading to significant problems with airway patency, voice production, and swallowing. We report a case of a 49 year old man admitted to the emergency room after a motor cycle accident with cervical trauma. The patient presented with hoarseness, anterior neck pain, cervical subcutaneous emphysema, and increasing respiratory distress that led to the tracheostomy of the patient. The computed tomography (CT) of the neck revealed a comminuted fracture of the thyroid cartilage, a hematoma of the left piriform sinus and cervical subcutaneous emphysema. The three-dimensional CT showed a double fracture of thyroid cartilage with displaced intermediate fragment. The patient underwent an open reduction and internal fixation of the thyroid cartilage with miniplates along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. We conclude that early diagnosis and appropriate therapy favorably alters the prognosis in terms of long-term voice and airway outcome.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Metastatic paranasal sinuses adenocarcinoma from breast carcinoma, a rare
           event: a case report

    • Authors: Tawfiq Khurayzi, Abdullah Alshahrani
      Pages: 1099 - 1102
      Abstract: Metastases to the nose and paranasal sinuses usually respond poorly to treatment and have a poor prognosis. We present a 31 year old lady with rare metastatic paranasal sinuses lesion which is adenocarcinoma that metastasis from breast carcinoma. All of clinical presentation, radiological findings, histopathological and immunohistochemically markers examination reveal metastatic adenocarcinoma. This study presents rare metastasis in head and neck cancer especially from breast to paranasal sinuses.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Continuous negative airway pressure “CNAP”: Novel nasal
           foreign body removal

    • Authors: Joyce Z. Teng, Arthur Y. Teng, Colin E. Sullivan
      Pages: 1103 - 1104
      Abstract: We report on a novel and innovative method used to extricate nasal foreign bodies in infants and young children– a common presentation in pediatric emergency care that can at times have potentially serious consequences. In the case of a three-year-old girl, ‘continuous negative airway pressure (CNAP)’ using a continuous positive airway pressure (CPAP) mask and a domestic vacuum cleaner, a nasal foreign body was removed quickly and effectively in a simple and painless procedure. While more cases are needed to confirm safety and efficacy, the principles underlying this technique could have great potential for future clinical use due to its simplicity and accessibility, particularly when compared to other techniques currently used in the home and in the emergency department.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Combined modality therapy for naso-oropharyngeal solitary extramedullary
           plasmacytoma: case report

    • Authors: Andrea Masarykova, Marin Dzongov, Alexandra Hanicova, Ingrid Zavacka, Danijela Scepanovic
      Pages: 1105 - 1110
      Abstract: Most patients with plasma cell neoplasia have generalized disease at diagnosis. However, some patients have a solitary extramedullary plasmacytomas (SEPs). SEPs are rare, typically solitary tumors comprising approximately 3–5% all plasma cell neoplasms. Almost 90% arise in the head and neck region, especially in the nasal cavity, sinuses, oropharynx, salivary glands and larynx. Solitary extramedullary plasmacytoma (SEP) has a predilection for the male gender and occurs most frequently in patients 50 years and older. SEP often runs an indolent clinical course with a tendency for local recurrence, and progresses to plasma cell myeloma in about 15% of patients. In this paper, we have reported the case of SEP of the naso-oropharynx in 55 years old woman who was presented with a sense of the nasal obstruction. The resection was performed and a mature plasmacytoma was demonstrated histologically. However, ENT examination and positron emission tomography/computed tomography examination with 18-fluorodeoxyglucose (18-FDG PET/CT) have shown that the patient had residual naso-oropharyngeal disease after surgery. A negative bone marrow biopsy and 18-FDG PET/CT have confirmed that it was a solitary extramedullary plasmacytoma of the head and neck region. Following the surgery, intensity modulated radiotherapy (IMRT) was administered. No relapse or progression to the multiple myeloma was recorded during the 3.5 years of follow-up. This case report, which describes a rare tumor of the naso-oropharynx, is expected to improve the recognition and referral of this condition in medical practice. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Mucoepidermoid carcinoma of the palatine tonsil: a case report and review
           of the literature

    • Authors: Ponnuswamy Karkuzhali, Bijayalaxmi Sahoo
      Pages: 1111 - 1113
      Abstract: Mucoepidermoid Carcinoma is the most common malignant salivary gland neoplasm. It is seen in both the adults and children and shows a slight female predilection. It presents, usually, as a painless, slow-growing, firm mass, with varied clinical behaviour depending on its clinical stage and histological grade. The majority of the cases occur in the major salivary glands, though it can also arise from minor salivary glands. It occurs, most commonly, in the buccal mucosa and palate in the oral cavity. Other sites, in which it has been reported, include maxilla, mandible, breast tissue, skin and thymus. To our knowledge, only three cases, have been reported in tonsils so far, and hence we report an uncommon case of mucoepidermoid carcinoma of the Palatine tonsil.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Atypical presentation of a large cervical schwannoma

    • Authors: Inderdeep Singh, Anubhav Singh
      Pages: 1114 - 1116
      Abstract: Hypoglossal nerve schwannomas are rare benign tumors arising from the schwann cells covering the hypoglossal nerve. These tumors are slow growing and their symptoms are usually due to pressure effects over the adjacent structures. We present a rare case of a large intracranial and cervical schwannoma arising from the hypoglossal nerve. We discuss the atypical presentation and vague symptoms with which a patient of hypoglossal schwannoma may present. Surgery in such cases requires the joint efforts of the team of Neurosurgeons and Otorhinolaryngology and Head and Neck surgeons.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • An unusual presentation of nasopharyngeal carcinoma

    • Authors: Kulwinder Singh Sandhu, Priyanka Chaudary, Anjana Kumari, Jagdeepak Singh
      Pages: 1117 - 1119
      Abstract: Nasopharyngeal carcinoma is one of the most difficult tumors to diagnose at early state and intracranial spread is common. We report the case of 45 years old Indian female with nasopharyngeal carcinoma, who presented with nasal obstruction and repeated cough and cold from last two months. X-ray PNS imaging revealed mild septal deviation to right side. Nasal endoscopy revealed lobulated greyish coloured mass involving both choana and mass protruded out on expiration. CT scan revealed soft tissue density in nasopharynx involving bilateral choanae. Excision mass done with presumptive diagnosis of lymphoma. Histopathological examination diagnosed non keratinizing undifferentiated nasopharyngeal carcinoma. Serum EBV-DNA levels were raised. Radiotherapy started immediately after diagnosis of NPC. Non-specific symptoms in this case, when followed up carefully diagnosed as NPC. Diagnosis is important for proper management.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Pharyngocutaneous fistula repair: case report and review of management

    • Authors: Raj Nagarkar, Gauri Sayaji Kokane, Ashvin Wagh, Shrikant Vanjari, Sachin Bansod
      Pages: 1120 - 1122
      Abstract: Incidence of post chemoradiation salvage laryngectomy complication rate is 3%-65%. It is most common but most annoying complication after salvage laryngectomy for surgeon to manage. When conservative measures fail to repair the fistula surgical means have to be considered. But even after surgical correction it takes time to heal due to local conditions. Here we present a case of surgical repair of pharyngocutaneous fistula and review of various management strategies.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Rare cervical nerve root C2-C3 schwannoma

    • Authors: Chandra Veer Singh, Shravan Shetty, R. K. Deshpande, Priyank Patel
      Pages: 1123 - 1125
      Abstract: 10% of schwannomas that occur in the head and neck region mostly originate from the vagus or sympathetic nervous system whereas those arising from C2 nerve root are extremely rare. Extracranial schwannomas in the head and neck region are rare neoplasms. Diagnosis is established by imaging studies such as magnetic resonance imaging or computed tomography, while FNAC is used to rule out other condition. Histopathology gives definitive diagnosis. The accepted treatment for these tumors is surgical resection with preservation of the neural pathway. We present a rare case of cervical nerve (C2-C3) root schwannoma of 50 year old male who presented with right lateral neck swelling with pain  radiating to right shoulder associated with right shoulder stiffness. The swelling which also had an intervertebral part was removed successfully through a posterior neck incision with no post-operative neurological symptoms.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • A large sinonasal schwannoma: a rare entity

    • Authors: Manwinder Singh, Sanjeev Bhagat, Dinesh Kumar Sharma, Rabia Monga, Nitin Chhabra
      Pages: 1126 - 1129
      Abstract: Schwannoma is a rare neoplasm of nose and PNS which develops from Schwann’s cells of neural sheath and most are benign and encapsulated and amenable to surgical excision. The aim of this write-up is to report a rare case of schwannoma of nose and PNS. We report a case of 40 year old female, a housewife, presented in ENT OPD with complaints of nasal obstruction on right side, post nasal drip and headache. On diagnostic nasal endoscopy, there was a polypoidal mass coming from the middle meatus which was pushing the medial turbinate medially. NCCT and MRI of nose and PNS showed soft tissue density mass involving right ethmoidal air cells, maxillary sinus and bilateral sphenoid sinuses and eroding the lateral wall of right maxillary sinus reaching upto infratemporal fossa, superiorly mass was seen eroding the inferior wall of right orbit. The tumour was removed endoscopically piecemeal and sent for histopathology which showed it to be a schwannoma. The conclusion of the finding was schwannoma involving nasal cavity, maxillary sinus and sphenoid sinus eroded the lateral wall of maxillary sinus going into infratemporal fossa and floor of the orbit. Schwannoma should also be kept as a possibility in the differential diagnosis of tumors of nose and PNS. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Sphenochoanal polyp: a case report

    • Authors: Kulwinder Singh Sandhu, Shiffali ., Jagdeepak Singh
      Pages: 1130 - 1132
      Abstract: Choanal polyp arising from the sphenoid sinus and presenting at the choana are rare. These are known as sphenochoanal polyp. We present a case of sphenochoanal polyp and its clinical features and surgical management is discussed. Our aim in this case was to properly delineate the origin of the polyp and differentiate it from other lesions such as the antrochoanal polyp and meningocele, followed by meticulous endoscopic excision of the polyp. Radiological investigations include a CT scan paranasal sinuses or a MRI diagnostic nasal endoscopy will confirm the diagnosis. Once the diagnosis is made surgical removal must be done.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Tubercular lymphadenitis presenting with facial palsy: a rare case report

    • Authors: Manish Munjal, Archana Arora, Amanjeet Singh, Vineeta Munjal
      Pages: 1133 - 1135
      Abstract: India has a very high prevalence of tuberculosis (TB). Incidence of extrapulmonary tuberculosis is on the rise and at times it presents with uncommon features. We reported a case of 27 year old female presented with an irregular scar mark in the submandibular region along with an asymmetric smile. She was on treatment for tuberculosis as diagnosed by an earlier aspiration cytology report. Examination showed irregular non tender scar along with an underlying 2×2 cms swelling. Repeat fine needle aspiration was inconclusive and the patient was thus taken up for excision biopsy. Final report turned out to be tubercular lymphadenopathy and treatment was thus started accordingly. We conclude that tubercular lymph nodes presenting with facial nerve paresis are extremely rare entity. A high degree of suspicion should be maintained in a country like India where prevalence of TB is significantly high. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Benign teratoma of neck in adult: a rare case report

    • Authors: Mohammed Humaam Ansari, Atishkumar Balajirao Gujrathi, Vijayalaxmi Ambulgekar
      Pages: 1136 - 1139
      Abstract: Cervical teratomas are extremely rare germ cell tumours. Cervical teratoma is much more common in newborn than adults, and in contrast to the paediatric cases adult teratomas have been highly malignant. Cervical teratoma incorporates lesions arising in the anterior and posterior triangles of the neck. Cervical teratoma can reach enormous size and cause airway obstruction.  Surgery is the primary modality of treatment as malignant transformation occurs. Hereby, we present a case of benign teratoma of neck in adult which was completely misdiagnosed preoperatively due to its rare occurence in adults. Even though cervical teratoma of adult is extremely rare, it should be considered as an important differential diagnosis in patient of midline cystic neck swelling. Preoperative radiological investigations requires high index of suspicion. Complete surgical resection is recommended. 
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
  • Hearing assessment in a rare case of Hajdu Cheney syndrome

    • Authors: Priyanka ., Shiffali ., Manpreet Singh, Jagdeepak Singh
      Pages: 1140 - 1142
      Abstract: Hajdu Cheney syndrome is extremely rare autosomal dominant congenital disorder of connective tissue. It may occur due to spontaneous de novo mutation and mutation in NOTCH-2 gene identified recently. Most characteristic features include aero-osteolysis involving phalanges of both hands and feet, osteoporosis, deformities of skull, mandible, spine and other bones, kyphoscoliosis and bone fractures. Rarely in some affected individuals, it causes joint hypermobility, dental problems, hearing loss, heart defects, kidney abnormality like polycystic kidneys, excess body hair and recurrent infections in childhood. It affects many parts of body particularly bones. Treatment is symptomatic. In this case report, we present a case of 14 years male child with features of Hajdu Cheney syndrome with genetic predisposition. Patient presented to ENT clinic with complaint of hearing loss.
      PubDate: 2017-09-22
      Issue No: Vol. 3, No. 4 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
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