Bengal Journal of Otolaryngology and Head Neck Surgery
Bengal Journal of Otolaryngology and Head Neck Surgery (BJOHNS) is the official journal of The Association of Otolaryngologists of India, West Bengal. It is an open access, double-blind peer reviewed and indexed journal published three times a year in both print and online formats.
The Association of Otolaryngologists of India, West Bengal
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A Follow-up Study on One Minute Paper as Feedback for Lecture Classes in Medical Education
ABSTRACT Introduction: To make the best use of the feedback, it is very important that the teacher analyses each and every feedback and make necessary changes in their teaching method and style. The “one-minute paper” or OMP is a very short, in-class writing activity, taking one minute or less to complete. The aim of our study is to assess the benefit of changing our teaching styles based on a previous OMP feedback. Methods: This study was carried out simultaneously in two different departments ( ENT and General Surgery ) in our hospital. The first feedback was taken and analysed. Based on the analysis, modifications were made in the teaching-learning process. The second feedback was taken one year later on the same topics but on a different ( subsequent ) batch. In each subject, the first and second feedbacks were compared and analysed. Results: We found that there was a significant drop in queries after introducing more videos, teaching by case base approach and focussing more on topics which students found difficult to understand. Conclusion: OMP is a very quick, simple and efficient method of obtaining student feedback in a large group. Analysing the responses helps in modifying subsequent lectures in a more student friendly way.
Copyright (c) 2025 Bengal Journal of Otolaryngology and Head Neck Surgery https://creativecommons.org/licenses/by-nc/4.0
Malignant Mucosal Melanoma of the Maxillary Sinus with Oro-Antral Fistula
Introduction – Sinonasal mucosal melanomas are uncommon, making up merely 0.5-2% of all malignant melanomas and 4% of melanomas in head and neck region. In the sinonasal region, they are very aggressive, commonly presenting at an advanced stage. Diagnosis is made using histopathological examination and immunohistochemistry by S100 and HMB-45 markers. Case Report - We describe a case of 62 years’ female with swelling in the maxillary area and an oroantral fistula at the right maxillary alveolus who underwent right endoscopic sinus surgery with septoplasty with partial medial maxillectomy and oroantral fistula closure which was diagnosed as malignant melanoma on histopathology and immunohistochemistry. Discussion – Malignant mucosal melanoma is a rare but aggressive disease originating from melanocytes located in the mucosa. It is characterised by swift nonspecific symptom progression and early metastasis. When the tumour is detected early and fully excised, malignant melanomas are majorly curable. However, once metastasis occurs, treatment options are limited.
Atypical Presentation of Fungal Skull Base Osteomyelitis: Middle Ear as the Primary Focus
INTRODUCTION:Skull base osteomyelitis (SBO) is a complex condition seen in immunocompromised patients with severe mortality and morbidity. Fungal SBO is very rare and mostly sinogenic in origin. Otogenic (middle ear ) fungal SBO is exceptionally rare.This case report details a case of atypical fungal SBO due to mucormycosis originating in the middle ear with its unusual clinical course. CASE REPORT: A 60 year old male with uncontrolled diabetes mellitus presented with left ear pain and multiple cranial nerve palsies. Initial imaging was suggestive of pansinusitis with SBO. Histopathology confirmed mucormycosis exclusively in the middle ear granulation tissue, not the sinuses, pinpointing an otogenic primary source.The patient received antifungal therapy with management of Diabetes Mellitus and other co-existing medical issues. DISCUSSION:This case highlights an extreme rare case of fungal skull base osteomyelitis from middle ear origin.It underscores the importance of histopathological examination given the initial misleading radiological findings. The patient showed a favourable response with medical management of Diabetes Mellitus and antifungal therapy despite his initial grim neurological presentation with multiple cerebral infarcts defying his grave prognosis. CONCLUSION: This case highlights that though fungal SBO aggressive symptoms and signs of fungal SBO can lead to severe complications.Inspite initial grim outlook, with vigilant management of underlying comorbid conditions and antifungal therapy there was remarkable clinical improvement.
Fungal Skull Base Osteomyelitis; Mucormycosis; antifungal therapy
An Observational Study of Anatomical Variations of Ostiomeatal Complex affecting Mucociliary Clearance
Background The ostiomeatal complex (OMC) is vital for sinus drainage and mucociliary clearance. Anatomical variations like deviated nasal septum (DNS) and concha bullosa may predispose to chronic rhinosinusitis (CRS). This study assessed the impact of DNS severity and variations on sinus involvement using Lund-Mackay (LM) scores. Materials and Methods A retrospective study of 73 patients (>18 years) undergoing Computed Tomography (CT) of paranasal sinuses was conducted. DNS was graded as: I (<5°), II (5–10°), III (10–15°), IV (>15°). Anatomical variations were recorded, and LM scoring applied to all sinuses and OMC. Statistical analysis included Spearman correlation and Chi-square test (p < 0.05 significant). Results Mean age was 38.8 ± 13.6 years; 58.9% had right-sided DNS. Concha bullosa was most common (n = 57). Right DNS strongly correlated with ipsilateral anterior ethmoid (ρ = 0.578, p < 0.01) and sphenoid (ρ = 0.460, p < 0.01) sinuses; left DNS correlated with anterior ethmoid (ρ = 0.463, p < 0.01) and maxillary (ρ = 0.311, p < 0.05) sinuses. Chi-square analysis showed significant associations for all right-sided sinuses and for left anterior ethmoid and maxillary sinuses. OMC obstruction was linked to markedly higher LM scores across ipsilateral sinuses. Conclusion DNS severity and OMC obstruction significantly affect sinus disease, especially anterior ethmoid and maxillary regions. Common anatomical variants did not independently predict severity. Preoperative CT evaluation should emphasize DNS and OMC for optimal CRS management.
Clotrimazole Cream versus Ear Drops for Otomycosis: A Randomized Trial
Introduction: Otomycosis is a superficial fungal infection of the external auditory canal with a global prevalence ranging from 9% to 30%. The increased use of antibiotic ear drops has contributed to its rising incidence. This study aimed to compare the effectiveness of clotrimazole cream and clotrimazole ear drops in managing otomycosis. Materials and Methods: A prospective, randomized controlled trial was conducted on 300 patients diagnosed with otomycosis. Patients were divided into two groups: Group A received clotrimazole cream administered by ENT specialists, and Group B used clotrimazole ear drops as self-medication. All participants were followed for four weeks, with clinical evaluations performed weekly. Results: After one week, Group A (clotrimazole cream) achieved a 98% resolution rate, while Group B (clotrimazole drops) achieved an 86% resolution rate. The cream group showed fewer treatment failures and recurrences compared to the drop group (p < 0.001). Conclusion: Clotrimazole cream is more effective than ear drops in treating uncomplicated otomycosis. Its occlusive application and higher compliance may contribute to superior clinical outcomes.
Assessment of Hearing Loss and Its Correlates among Industrial Workers of Kanpur
Introduction Prolonged noise exposure poses a substantial risk to public health, resulting in noise induced hearing loss. This purpose of this study to assess the magnitude of occupational noise induced hearing loss and to study its correlation with various contributing factors. Materials &Methods A prospective longitudinal study was conducted on 426 industrial workers, aged 18-55 years, predominantly men (mean age 39.83 ± 0.76 yrs), exposed to noise levels of 85 dB or higher. Hearing assessments were conducted by Pure Tone Audiometry at time of presentation and followed up at 3, 6 and 12 months. Result Hearing loss affected 39.7% (169/426) of workers, mainly aged 30–50 yrs, with mild bilateral sensorineural impairment. A statistically significant association was found with noise exposure duration, intensity, and daily working hours. However, one-year follow-up showed no correlation, indicating that long-term exposure is key to hearing loss development. Conclusion The study highlights the need for regular hearing assessments, mandatory use of protection devices, and stronger conservation measures, as prolonged noise exposure, long work hours, and high sound levels significantly increase hearing loss risk.
Unilateral Sinonasal Masses: Insights from a Retrospective Study
Introduction Unilateral sinonasal masses are a common clinical entity in otolaryngology, often presenting with nonspecific symptoms. Although inflammatory lesions predominate, neoplastic conditions may present similarly, necessitating a high degree of clinical vigilance. Materials and Methods A retrospective analysis was conducted on patients presenting with unilateral sinonasal masses at a tertiary care centre between January 2021 and December 2022. Based on histopathological evaluation, cases were stratified into inflammatory and neoplastic groups. Demographic characteristics, clinical presentation, radiological findings, and treatment outcomes were analysed. Results The study included 34 patients (mean age: 35 ± 16 years), with a male predominance (64.7%). Inflammatory lesions accounted for 79.4% of cases, with inflammatory polyps being the most prevalent histological subtype (29.4%). Neoplastic lesions comprised 20.6% of cases, including a single instance (2.9%) of poorly differentiated squamous cell carcinoma. The majority underwent endoscopic surgical management, predominantly functional endoscopic sinus surgery. No recurrences were observed during one year of follow-up. Conclusion Inflammatory polyps represent the most frequent aetiology of unilateral sinonasal masses. Given the diagnostic overlap with neoplastic lesions, comprehensive evaluation incorporating endoscopy, imaging, and histopathology remains imperative for accurate diagnosis and optimal management.
Significance of Tissue Eosinophilia and Zinreich CT Scan Scoring in Nasal Polyposis
INTRODUCTION:Chronic Rhinosinusitis with nasal polyp is chronic inflammatory condition of sinuses and nasal cavity characterized by the presence of benign and hyperplastic growths called nasal polyps. nasal tissue eosinophilia can predict the disease severity and prognosis of the disease.in this study an attempt has been made to find an association between nasal tissue eosinophilia and Zinreich CT scan scoring. MATERIALS AND METHOD:The Observational study was conducted in a tertiary care centre involving 40 patients with nasal polyposis who underwent FESS All patients underwent preoperative CT scan and modified Lund Mac Kay(Zinreich) scoring.Excised polyp tissue was sent for histopathological examination and eosinophil count was calculated per high power field. eosinophil count was categorized inti two groups:(=< 10 per high power field) and > 10 per high power field . We found that 15 patients had <= 10 E/hpf and 25 patients had > 10 E/hpf with mean CT scan scoring of 24.13+-18.9 and 37.8+-9.79 respectively. In our study it was also found that 10 patients who had not undergone FESS previously had 0-5 E/hpf and 6 patients who had undergone FESS previously had 10 -15E/hpf indicating that tissue eosinophilia is significantly high in recurrent nasal polyps. CONCLUSION: There was moderate degree of correlation between nasal eosinophilia and CT scan scoring with p value< 0.0001. The no of eosinophils in histopathological specimen is an important diagnostic modality to predict the recurrence of nasal polyps after FESS.
Parotid Lymphangioma: A Rare Diagnostic Puzzle in Head and Neck Pathology
Introduction: Lymphangioma is a rare, benign lymphatic malformation, most commonly seen in children and infrequently involving the parotid gland in adults. Its presentation often mimics other parotid masses, posing a diagnostic challenge. Diagnosis is typically based on clinical examination, imaging, and confirmed by histopathology. Case Report: A patient presented with a congenital swelling on the left side of the neck. Clinical examination revealed a soft, lobulated, mobile, non-tender mass measuring approximately 5×5 cm in the infra-auricular region extending to the mandibular area. Fine-needle aspiration cytology (FNAC) suggested a benign cystic lesion. Surgical excision was performed via a modified Blair incision under general anesthesia. The mass was sent for histopathological examination, which confirmed lymphangioma.The postoperative period was uneventful, and the patient was discharged in stable condition. Discussion: Though rare, parotid lymphangioma should be considered in the differential diagnosis of parotid region masses in adults. A combination of clinical assessment, imaging, and histopathological evaluation is essential for accurate diagnosis and appropriate management.
Spindle Cell Sarcoma of Pharynx: A Rare Case with Successful Management
Introduction Spindle cell sarcoma is a rare and aggressive malignancy characterized by spindle-shaped tumour cells. It can arise from various anatomical sites from soft tissue or bone. Involvement of the pharynx is relatively rare. This case report presents a unique case of spindle cell sarcoma in the pharynx, initially misdiagnosed as a vallecular space-occupying lesion on Fiber Optic Laryngoscopy but later confirmed as arising from the lateral wall of pharynx on HRCT. Accurate diagnosis and prompt management are essential for optimizing patient outcomes. Case Report A 57-year-old male patient presented to the ENT clinic with a two-month history of stridor and difficulty in swallowing. The patient had no significant medical or surgical history. Fibre optic laryngoscopy revealed a large vallecular space-occupying lesion obstructing the airway and impeding deglutition. The patient was scheduled for surgery after a thorough clinical and radiological evaluation. Contrast enhanced CT scan reveals SOL arising from the left side of pharynx with contrast uptake. Discussion Spindle cell sarcoma of the pharynx is a rare entity with limited reported cases. It poses a diagnostic challenge due to its atypical presentation and overlapping histopathological features with other spindle cell tumours. Immuno histochemistry plays a crucial role in confirming the diagnosis by evaluating specific markers. Surgical excision remains the primary treatment modality, often combined with adjuvant therapy depending on the stage and extent of the disease.
malignant peripheral nerve sheath tumour
Hearing Assessment and Noise-related Attitudes among Traffic Policemen of Puducherry
Background : To determine the hearing loss and evaluate the noise-related attitudes among Traffic policemen of Puducherry. Methods : A community based cross-sectional observational study was carried out involving 76 traffic policemen aged 20 to 60 years, employed in and around Puducherry, aimed at assessing attitudes related to noise and determine hearing loss through Otoacoustic Emission test(OAE). Those individuals who exhibited OAE refer were then further evaluated using Pure tone audiometry. Results: Out of 76 study participants, 69% were OAE pass and 31% were OAE refer. Out of 31% OAE refer, the prevalence of hearing impairment was 58.30% for mild, 29.10% for moderate and 12.60% for severe sensorineural hearing loss. Around 73.7% of study participants reported daily noise exposure level of 85-90 decibels. Only 40% of study participants were aware of hearing protection measures, however majority expressed concern about the potential impact of noise on their health. Conclusion : This study revealed that traffic policemen are at constant risk of noise-induced hearing loss (NIHL). Therefore, regular periodic hearing assessment needs to be done.
Otomycosis with Tympanic Membrane Perforation: Treatment Using Clotrimazole Soaked Gelfoam
Introduction: Otomycosis with a perforated tympanic membrane is commonly encountered in clinical practice and can pose a challenge to treat since commonly used clotrimazole ear drops can irritate the middle ear cavity. Here, the objective of the study was to use self-absorbing material like gelfoam soaked in antifungal cream as a patch over the tympanic membrane perforation to reduce seepage of clotrimazole solution into the middle ear and patient's compliance was studied. Materials and Methods: 26 patients presenting to the out-patient department with otomycosis and a perforated ear drum underwent thorough aural toileting followed by placing multiple pieces of gelfoam soaked in clotrimazole cream to patch the perforation. Patients were then asked to continue clotrimazole ear drops for 2 weeks and were followed up. Compliance to treatment in the form of pain tolerance and response to therapy were noted down. Results: 44% of patients complained of pain of which 28% experienced mild and 11% experienced moderate pain at the beginning of therapy. 13 out of 26 experienced mild pain on continuing therapy and all but one were compliant with the entire treatment. 73% of patients had complete resolution at the end of 2 weeks and the remaining 6 out of 26 needed additional week of ear drops for complete resolution. 3 of them with a pinpoint perforation had a healed membrane at the end of the therapy. Conclusion: Using Clotrimazole-soaked gelfoam pieces may be a safer and more effective alternative for enhancing treatment compliance, achieving better disease clearance, and reducing the number of follow-up visits.
Ear Nose Throat Manifestations in Head Injury Cases Necessitating Hospitalization
Introduction: Major consequences of head injury arise either from traumatic brain injury or from temporal bone fracture. Critical intracranial injuries often demand early management, thus overlooking ear nose throat manifestations. This study was undertaken to highlight the otorhinolaryngeal manifestations necessitating hospital admission in cases of head injuries. Material and methods: A prospective study was conducted in a tertiary care hospital of Indian Armed Forces to study the otorhinolaryngeal manifestations necessitating hospital admission in 30 patients of head injuries fulfilling the requisite criteria. After a thorough clinical examination, appropriate radio-imaging studies were done for head injury, temporal bone fracture and nasal fracture. Hearing was evaluated by pure tone audiogram. Data was analyzed using validated statistical software. Results: Majority were male in the age group of 30-40 years having sustained head injury in road traffic accidents. 90% patients showed otological manifestations including ear bleed, Battle sign, hemotympanum, perforation of tympanic membrane, hearing loss, tinnitus, vertigo, nystagmus, facial palsy, and CSF otorrhea. 50% cases of otic capsule violating fractures were complicated with facial palsy, sensorineural hearing loss, tinnitus and vertigo. Nasal findings were noted in 56.6% cases which included epistaxis, impaired olfaction, CSF rhinorrhea and maxillofacial fractures. Extradural hemorrhage, subarachnoid hemorrhage and subdural hemorrhage were seen in 23.3% cases. There were no cases with throat manifestations. Conclusion: A large proportion of cases of head injury necessitate hospitalization for management by a multi-specialty team. Major consequences of such events arise either from brain injury or from temporal bone fracture. Though life-saving neurosurgical intervention is always a priority, timely appropriate attention to otorhinolaryngeal morbidities cannot be overemphasized.
A Rare and Challenging Case : Trident Injury to the Neck
Introduction : Penetrating neck trauma though rare (5-10 % of all trauma cases) carries a high degree of morbidity and mortality. They not only pose a challenge to the surgical team but also to the anesthesia team with respect to securing the airway and induction of general anesthesia. Case Report : We report a case of a 9 year old male child who presented with penetrating neck trauma with a metallic trident. Clinically the child was stable and had no signs and symptoms of potential neurovascular injury. Xray examination in antero-posterior and lateral views revealed that the trident had missed the vascular structures of neck and the spine. Surgical removal of the metallic trident was planned after proper informed consent. Patient was intubated in lateral decubitus and the metallic trident was successfully removed from the neck in retrograde manner along the path of entry after incising along the entry wound to dislodge the foreign body from the submuscular plane. Discussion : Relevant literature was reviewed to understand appropriate management strategies. Neck injury by penetrating metallic foreign body should be done in a systematic manner comprising of clinical, radiological and anesthetic assessment. Vascular injury to be assessed at the earliest. Intubation in the lateral decubitus is a very effective method of securing the airway and induction and maintenance of anesthesia under such situations. Conclusion : Exclusion of neurovascular injury in penetrating neck trauma is of utmost importance in selection of imaging modality for the specific case. Multi-disciplinary team approach is desirable in selected cases with an experienced anesthesia team well versed in lateral decubitus intubation, videolaryngoscopy and flexible fibreoptic bronchoscopic intubation.
Influence of Intercanthal Distance Variation in Locating Lacrimal Sac during Endonasal Dacryocystorhinostomy
Introduction: Endoscopic endonasal dacryocystorhinostomy is one of the leading modalities for the treatment of distal lacrimal system obstruction. Knowledge of an accurate position of lacrimal sac in the lateral nasal wall is crucial to perform this surgery and to obtain favorable long-term results. This study is an attempt to define the position of lacrimal sac in the lateral nasal wall in relation to axilla of middle turbinate which is a well-accepted anatomical landmark on the lateral nasal wall to perform endonasal dacryocystorhinostomy; in extension, a variation in the inner intercanthal distance of the subject was correlated with any variation in the distance between the axilla of middle turbinate and lacrimal sac. Methods: An observational cross-sectional study was conducted on thirty patients with epiphora. Patients were evaluated with lacrimal syringing and those with distal lacrimal system obstruction were included in the study. Inner intercanthal distance was measured using vernier caliper. All patients underwent endoscopic endonasal dacryocystorhinostomy and intraoperative measurement between the axilla of middle turbinate and midpoint of lacrimal sac in the anteroposterior dimension was recorded. Results: Females predominantly presented with epiphora. The average anteroposterior distance of lacrimal sac from the axilla of middle turbinate in the lateral nasal wall was found to be 7.06mm with a range of 6mm to 8mm. Intercanthal distance in our study population had a range of 26mm to 38mm with a mean of 31.46mm. Statistically significant correlation could not be established between the inner intercanthal distance and position of lacrimal sac in relation to the axilla of middle turbinate. Conclusion: The lacrimal sac can be located 6mm to 8mm anterior to the axilla of middle turbinate. However, it does not correlate with varying inner intercanthal distance. The knowledge of accurate position of lacrimal sac in the lateral nasal wall is important to perform an endoscopic endonasal dacryocystorhinostomy and to obtain good long-term results.
endoscopic endonasal dacryocystorhinostomy
Microbial Spectrum and Antibiotic Resistance Patterns in Chronic Otitis Media: A Cross-Sectional Study with Emphasis on Atypical Organisms
Background: Chronic Otitis Media (COM) is a persistent inflammatory condition of the middle ear with a high global prevalence, particularly in developing countries. The emergence of drug-resistant and atypical pathogens underscores the need for regular microbiological surveillance. Objective: To determine the microbial profile in active COM, focusing on atypical organisms and their antibiotic susceptibility. Methods: A prospective cross-sectional study was conducted at a tertiary care hospital in Kolkata from February 2021 to August 2022. A total of 150 patients with active COM were enrolled. Aural discharge samples were cultured and analyzed for antibiotic sensitivity using Kirby-Bauer disc diffusion and the VITEK system. Results: Of the patients, 63% were female and 84% had positive cultures. The right ear was more often affected (55%), with mucosal COM being more common (83%). Gram-negative bacteria (63%) predominated, mainly Pseudomonas aeruginosa (30%), Staphylococcus aureus (22%), and Klebsiella pneumoniae (9.3%). Pseudomonas showed fluoroquinolone sensitivity, while Staphylococcus and Klebsiella showed resistance. Rare pathogens included Stenotrophomonas maltophilia, Proteus hauseri, and Alcaligenes faecalis. Conclusion: Chronic Otitis Media shows a female preponderance, with Pseudomonas aeruginosa and Staphylococcus aureus as the most commonly isolated pathogens. The emergence of atypical and drug-resistant organisms underscores the need for culture-guided therapy and regular antibiogram surveillance. Patients should be encouraged to adhere to the full course of prescribed antibiotics to minimize resistance and improve outcomes.
Chondroblastic Osteosarcoma of Nasal Bone: Report of a Rare Case
Introduction Chondroblastic osteosarcoma is a rare malignant bone tumor characterised by the presence of osteoid and cartilagineous components and its occurence in the lateral nasal wall is extremely uncommon which presented with nasal obstruction. Case Report A- 15- year old boy presented with a history of chronic right nasal obstruction lasting for more than 1 year. It was gradually progressive in nature. Clinical examination revealed a large sinonasal mass in the right nasal cavity which extended upto the middle meatus on Anterior Rhinoscopy. On Posterior Rhinoscopy the mass extended into the maxillary sinus . It was senseless on probing and free on medial side and . Laterally, the probe could not be moved as mass was attached. Discussion Chondroblastic Osteosarcoma of the lateral nasal wall and nasal bone is an extremely rare entity and only a few cases have been reported in the literature. It predominantly affects the adolescents and young adults with a slight male predominance. The clinical presentation is often non specific and includes sypmtoms such as nasal obstruction, facial swelling, epistaxis,facial swelling and pain. Radiological imaging including CT and MRI is essential for assessing tumor extent and involvement of adjacent structures. Surgical management with wide excisionis the mainstay of treatment. Adjuvant Chemotherapy and Radiotherapy may be considered depending on the risk factors. Histopathological examination and Immunohistochemistry plays a crucial role in confirming the diagnosis.
Cat Scratch Disease - A Diagnostic Dilemma in Cervical Lymphadenopathy
Introduction: Cervical lymphadenopathy in adults can be infective, benign or malignant. Wide spectrum of clinical diagnosis is possible as patients experience constituitional symptoms along with regional lymphadenopathy. Histopathological examination and serological tests provide diagnostic confirmation for accurate treatment. Case series: This is a descriptive case series study conducted at a tertiary care centre between Feb 2023- March 2025. We report the clinico-epidemiological profile and management of 3 patients with cat scratch disease. All patients presented with cervical lymphadenopathy and were diagnosed and managed with surgery and antibiotics. Discussion: Cat scratch disease is an uncommon cause of cervical adenopathy in India. It is a benign self-limiting disease caused by Bartonella Henselae. Histopathological examination can vary from lymphoid hyperplasia to chronic granulomatous inflammation with necrosis. All patients in our case series were managed successfully and were followed for 6 months post treatment. Conclusion: Cat scratch disease though rare should be included in the differential diagnosis of cervical lymphadenopathy in India.
Cat-Scratch Disease; Lymphadenopathy; Lymph Nodes
Comparative Study of Temporalis Fascia and Tragal Cartilage Grafts Used in Myringoplasty
Introduction: In myringoplasty, the choice of graft material is crucial for the successful outcome of surgery. The selection of ideal graft is directly related to the size and location of the perforation and also surgeon’s preference. In this study, we compared the efficacy of temporalis fascia graft with tragal cartilage on hearing outcomes. Aim: To compare the hearing outcomes between temporalis fascia graft and tragal cartilage graft in myringoplasty. Objectives: To compare the postoperative hearing improvement between the temporalis fascia graft group and the tragal cartilage graft group. Materials & methodology: In this retrospective study, the records of 40 patients who underwent myringoplasty were included out of which 20 patients (group A) underwent type 1 tympanoplasty with temporalis fascia graft and 20 patients (group B) underwent type 1 tympanoplasty with tragal cartilage graft. Both groups were assessed for hearing on the day before surgery and compared with hearing assessment done 3 months following surgery. Results: There was no statistically significant difference between the postoperative air-bone gap values of Group A and Group B (p < 0.001). Conclusion: This study validates that both graft types effectively restore hearing levels. Keywords : Tympanoplasty, temporalis fascia, tragal cartilage, myringoplasty, grafts
Tympanoplasty, temporalis fascia, tragal cartilage, myringoplasty, grafts
Sphenoid Sinus Mucoceles – Our Experience
Background: Mucoceles of the sphenoid sinus act as benign lesions and can result in bony erosion from within its continuity of the sinus to the intracranial and orbital spaces. Disease restricted to the sphenoid sinus is rare and often manifests with nonspecific or subtle signs and symptoms. Early and accurate diagnosis of sphenoid sinus disease may thus be difficult. Otolaryngologists must have a thorough knowledge of the spectrum of sphenoid sinus disease and the radiologic characteristics to manage these patients properly. The increased use of endoscopy in routine examination and advances in techniques of imaging, this area will result in the more frequent diagnosis of these lesions. Methods: We herewith report 10 cases of chronic rhinosinusitis with sphenoidal mucocele with or without polyposis. All patients underwent detailed history taking, and a thorough examination followed by DNE and CECT of the Nose and PNS. All patients underwent functional endoscopic sinus surgery and swab was sent for KOH and HPE was done for biopsy. With regular follow up on 1st month , 6th month and 12th month showing no evidence of recurrence to date. Conclusion: variable nonspecific symptoms and the complex anatomy of the sphenoid sinus tend to delay the diagnosis resulting in a poor prognosis. Keywords: Mucocele, sphenoid, polyposis.
Management of Benign Neck Swellings involving Different Compartments – Case Series
Introduction and objective: Neck has a complex anatomy with important neurovascular structures and divided into several compartments. Swellings of different etiology and pathogenesis occur in the neck giving rise to varied signs and symptoms. Surgical management of such swellings may be difficult as their location may be related to important neurovascular structures of neck giving rise to complications if any inadvertent injury happens during surgery. The main objective of this study is to enlighten the difficulties and complications we faced in managing a series of 4 cases with different neck swellings in different compartments. Case series: In this article, we present 4 different cases of neck swellings – cystic hygroma, huge autoimmune thyroid swelling, deep part of submandibular gland sialolithiasis and submental arteriovenous malformations having different etiology arising in different compartments related to different structures with their management. Conclusion: To manage a case of neck swelling proper history, examination, appropriate investigations and thorough anatomical knowledge of site, fine surgical skills with experience may be required to prevent complications and to perform successful surgery.
Evaluation of Quality of Life after Rhinoplasty
Abstract Introduction Rhinoplasty is the most common cosmetic surgery performed by otorhinolaryngologist and plastic surgeons. It can be done for both aesthetic and functional purposes. Quality of life of the patient becomes important, so in this study we will assess the quality of life of patients using outcome evaluation scores. Materials and methods This prospective longitudinal clinical study was performed on patients who visited to Department of Otorhinolaryngology from March 2023 to April 2024 and underwent open rhinoplasty. Rhinoplasty Outcomes Evaluation(ROE) and Rhinoplasty health inventory and nasal outcomes(RHINO) was applied to all patients and evaluated pre and post operatively. Results obtained and statistically assessed. Results A total of 16 patients were studied, which shows improvement of ROE and RHINO scores from preoperative to postoperative and followed by 3 months. Conclusion The statistical significance of the improvements seen at the 3-month and postoperative follow-up points to the fact that rhinoplasty produces notable and long-lasting gains in both functional and cosmetic results.
Positive Incidence of ABR in Newborns Detected to Have “Refer” in DPOAE
Introduction: OAE & ABR are screening tests used for newborn screening. The main objective of the study is to determine the incidence of positivity of ABR in newborns detected to have “Refer” in DPOAE in UNHS(Universal Newborn Hearing Screening). Materials & Methods: A prospective observational study was conducted at a tertiary care center over a period of one year from Jan 2020 to July 2021. All neonates will be screened by DPOAE between day 1 to day 28 (first visit). If it is reported ‘Refer’, DPOAE will be repeated either after 6 weeks or on the first immunization day (second visit). If it is again reported as ‘Refer’, the neonate will undergo ABR (third visit). The results were recorded & compiled. The data was analysed statistically using SPSS software (version 20). Results: Out of the 409 neonates, 315 (77.0%) were reported as “Pass” and 94 (23.0%) were reported as “Refer” during DPOAE first visit. The neonates (94) with test result “Refer” in DPOAE 1 (first visit) were considered for DPOAE 2 (second visit) & 77 (83.0%) were reported as “Pass” and 17(17.0%) were reported as “Refer”. The 16 infants who underwent Diagnostic ABR, 6 (37.5%) were reported as “Normal” whereas 10(62.5%) were reported as “Abnormal” group. Conclusion: This study recommends universal screening with OAE & ABR to facilitate early detection of auditory neuropathy and to initiate aural rehabilitation, especially in high-risk groups such as NICU & preterm neonates Keywords: OAE(Otoacoustic emissions), ABR (Auditory Brainstem Response) , UNHS(Universal Newborn Hearing Screening).
DPOAE (Distortion Product Otoacoustic Emission) ,
Fine Needle Aspiration Cytology of Head & Neck Lesions- Single Centre study in a Rural Medical College
Introduction: Diagnosis of swelling in the head and neck region is challenging due to the diversity of entities. Introduction of FNAC in diagnostic protocol of Space Occupying Lesion (SOL) of head and neck region has reduced the number of unnecessary surgery and excision biopsy. Existing Literature review indicates that clinical history and anatomical site of the lesion are valuable in terms of narrowing down the differential diagnosis of a SOL in head & neck region. FNAC has contributed a great deal to transform cytology from a primarily screening tool to a powerful diagnostic technique. With this background knowledge, the present study was performed to evaluate the wide spectrum of lesions diagnosed on Fine needle aspiration cytology (FNAC) in patients with head and neck swellings and to know the efficacy of FNAC in diagnosing head and neck lesions Materials and methods: The present prospective, observational single hospital based study was conducted in a tertiary care centre and medical college in eastern India, catering mainly rural population. Eighty (80) patients were included in the study, after obtaining written consent, presenting with superficially palpable swellings of head and neck area. After explanation of procedure and taking informed consent of patient, FNAC was done using 10 cc disposable syringe and 22 gauge needle maintain appropriate procedure. Three or four smears were prepared following standard guidelines. Smears were stained with Papanicolaou and Leishman-Giemsa stain. Ziehl- Neelsen staining for acid fast bacilli was done in suspected tubercular lesions. Cytomorphological diagnosis was given. For statistical analysis data were entered into a Microsoft excel spreadsheet. Data had been summarized as percentages for categorical variables. Results: In our study, maximum number of patient are in the age group of 16-45 years (65%) with a female preponderance. Lymph node (45%) is the most common site of FNAC followed by thyroid gland (24 %) and salivary gland (16%). Among the lymph node swellings, tubercular lymphadenitis is the commonest diagnosis. Among malignant cases of lymph nodes, metastatic carcinoma was seen in 8.3%. In these cases FNAC not only confirmed the malignancy but also gave a vital information regarding type of carcinoma (adeno or squamous) and so about the primary site of the malignancy. In salivary gland lesions, Pleomorphic adenoma appears to be the commonest cytological diagnosis followed by sialadenitis cases. Regarding cytopathology of thyroid aspirates, in our study, 50% cases appeared as nodular colloid goiter.16.6% cases were lymphocytic thyroiditis and 12.5% cases were papillary carcinoma. Cytopathology of other miscellaneous lesion of head and neck area aspirates show that inflammatory lesions constitute 25% of the cases. Conclusion: Due to technical ease, considerable accuracy and cost effectiveness, FNAC is an excellent screening test in the diagnosis of head and neck swelling and it is used as first-line investigation in diagnosing head and neck swellings nowadays. However, as seen in our study and in comparison to other similar studies, it is important to note that the diagnostic accuracy of FNA is variable for different conditions. Ultra- sound guidance (USG guided) and sampling from representative sites are sometimes necessary to improve the yield and diagnostic accuracy of FNAC. Introduction of FNAC in diagnostic protocol of head and neck area space occupying lesion (SOL) has reduced the rate of open tissue biopsy as well as unnecessary surgery.