Background: There are several physiological changes seen in pregnant women and among them, laryngeal changes are quite important. The laryngeal manifestations in pregnant women are mainly due to changes of the sex hormones levels and these returns to normal in postpartum period. Objective: The objective is to study the laryngeal manifestations in pregnant women. Materials and Methods: This is a prospective observational study where 54 pregnant women participated in this study for laryngeal manifestations. A questionnaire was asked to all participants for assessing the laryngeal manifestations in pregnant women. Eighty-four pregnant women in the age group of 22–35 years participated in this study. They underwent complete laryngeal and obstetric examination. Indirect laryngoscopy and laryngeal endoscopic examinations were done in all cases for the evaluation of hearing loss. Results: The mean age of the pregnant women participated in this study was 26.23 years. The most common otological manifestation was foreign body sensation in throat and it common in first trimester of the pregnancy. Dysphonia was found in 22.22% of the cases. Other manifestations were laryngopharyngeal reflux and hoarseness of voice. Conclusion: The alteration of the hormonal milieu in pregnant women can lead to several laryngeal manifestations such as foreign sensation in throat, change in voice, and irritating cough. Although there are several laryngeal manifestations are seen in pregnant women, yet these manifestations often neglected in clinical practice.

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Foreign body (FB) sensation in the throat is often a common symptom encountered in clinical practice. FB sensation in throat has numerous causes. Long-standing FB in the soft tissue of the neck is sometimes asymptomatic and presents only with throat irritation or FB sensation, although it is an extremely rare incidence. The diagnosis of this clinical event is based on the clinical presentations and imaging. The treatment is done by securing the airway, removal of FB, and antibiotic coverage. Here, we report the case of a 16-year-old boy presenting with chicken bone embedded in the soft tissue of the posterior pharyngeal wall and retropharyngeal space for 2 months in the throat without any major symptoms except FB sensation. Imaging confirmed the diagnosis of chicken bone in the retropharyngeal space with mild abscess formation, which was removed by transoral approach.

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Schwannoma is a benign nerve sheath tumor whose the most common site is the vestibulocochlear nerve. Sinonasal schwannoma is rare and septal schwannoma is even more rarer. We report a endonasal endoscopic-guided excision of the left nasal cavity mass attached at the nasal septum in a 59-year-old female which on histopathological examination was confirmed as schwannoma.

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Noise pollution is increasingly being recognized as a major health problem in India. An increased incidence of noise-induced hearing loss (NIHL) has been observed in recent years. Several advances have taken place in the understanding of the molecular basis of NIHL. This can help in evolving preventive and treatment strategies. Research in genetics is progressing at a rapid pace, and several genes linked to NIHL have been identified. In the future, gene therapy may be available as a management modality. This paper will focus on the current research and future trends on the auditory effects of noise pollution.

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Introduction: Mucormycosis is a rare clinical entity and often affects immunocompromised patients. It is caused by the fungus of the order Mucorales. Rhizopus species are the most common causative organism associated with mucormycosis. It is an emergency situation and has poor prognosis.Materials and Methods: A retrospective study included eight patients with head-and-neck mucormycosis diagnosed over a 3-year period from December 2016 to March 2019. Results: There are five male and three female patients, aged from 29 to 65 years. Out of eight patients, four were diabetic and the rest were with hematological disorders. There were five sinonasal mucormycosis and three nonsinonasal involvement. Diagnoses were confirmed by histopathological examination. Two cases were fatal due to cerebral involvement.Conclusion: Prompt diagnosis with tissue biopsy, local control of the disease by aggressive surgical debridement, and appropriate systemic antifungal treatment improve the prognosis and survival of the patients. Treatment of mucormycosis needs antifungal agents such as amphotericin B and wide surgical debridement. Early diagnosis and treatment is often needed for survival of the patients.

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There are a number of complications after thyroid surgery such as compressing hematoma, tracheomalacia, wound infection, damage to the recurrent laryngeal nerve or superior laryngeal nerve, hypothyroidism, hypocalcemia, scar formation, and thyroid storm, but discharging skin sinus of the neck is a rare complication. We report a case of discharging pus sinus of the neck after hemithyroidectomy for 1 year; pus culture was positive for Pseudomonas aeruginosa. Thyroid function test was normal. Ultrasonography disclosed branching sinus tracts and right lobe thyroid nodule and the left lobe not visualized. Sinus tracts' excision surgery was done. Histopathology report revealed fibrocollagenous stroma with clusters of epithelioid cells, histiocytes, Langhans giant cells, and chronic inflammatory cells with foci of caseous necrosis. The diagnosis of thyroid tuberculosis (TB) was therefore made. Patient was put on isoniazid, rifampicin, ethambutol, and pyrazinamide. She responds well. Although seldom observed, TB should be kept in mind in the differential diagnosis of discharging sinus of neck.

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Aim: This study aimed to find out the antibacterial and antifungal properties of the human cerumen. Materials and Methods: This is a prospective study conducted at the department of otorhinolaryngology and medical research laboratory of a tertiary care teaching hospital of Eastern India between December 2016 and November 2018 for assessing the antibacterial and antifungal properties of the human cerumen. Cerumen was collected from 102 healthy persons by using sterile Jobson Horne Probe. Sterile samples were taken for the study. Results: Out of the 102 samples, 68 sterile samples were considered for the study. At a dilution of 1 in 10⁵, there was complete inhibition of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa in all the samples. In this study, cerumen inhibited the bacteria in the order of E. coli > S. aureus > P. aeruginosa > Haemophilus influenzae > Aspergillus niger > Candida albicans. Conclusion: Cerumen or earwax of the human being has antibacterial and antifungal properties. Other than antibacterial and antifungal properties, it also protects the eardrum by acting as a physical barrier. Hence, cerumen cleaning is not advisable unless it is causing symptoms such as otalgia or hearing loss.

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A 11 year female presenting with sorethroat and diagnosed as peritonsillar abscess ,drained outside under aseptic precautions lead to bleeding, later presented with hemiparesis with DSA revealing a large pseudoaneurysm formation in ipsilateral carotid with patchy infarcts on CT. At emergency repeat bleeding occurred and patient started deteriorating following which the patient was managed by endovascular parent vessel occlusion following which she recovered gradually with regaining normal strength in paretic limbs within a few days . The case highlights the dreadful complication of peritonsillar abscess drainage as well as its endovascular management.

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Tissue biopsies are temporally and spatially limited and often provide a brief snapshot of a single region of a heterogeneous tumor. Carcinogenesis is a complex process in which heterogeneity plays an important role in the development and progression. Research efforts are going on focusing on the discovery of new, noninvasive methods for the diagnosis, and comprehension of the tumor genomic architecture to monitor tumor evolution and therapeutic response in real time. Liquid biopsy is a noninvasive diagnostic tool that can provide a personalized snapshot of primary and metastatic tumor at successive time points, providing knowledge of the tumor burden so as to detect early evidence of recurrence or resistance to the disease and helping clinicians in their therapeutic decision-making. Therefore, using liquid biopsies, we can obtain a molecular profile for each patient. We intended to review cell-free DNA (cfDNA) in oral cancer. We described cfDNA considering their levels, diagnostic value, prognostic value, predictive value.

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Aims: To test the validation of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires (QLQs), the core module QLQ-C30, and the head and neck module QLQ-H and N35 in a tertiary care center. Materials and Methods: Forty head-and-neck cancer patients completed the QLQ-C30 and the QLQ-H and N35 during their treatment. Questionnaires given to them were translated into their regional language Kannada. Evaluation of the responsiveness, reliability, and validity of the questionnaire was undertaken. Results: The data support the reliability of the scales. Validity cannot be assessed. The questionnaire was responsive to change over a period of time; however, the applicability of the European questionnaire in Indian clinical setup is debatable. Summary: This data suggest that the EORTC QLQ-C30 and the QLQ-H and N35 are reliable and responsive when applied to a sample of head-and-neck cancer patients in India. Hence, it can be used as a platform to test validity at a multicentric level. Conclusion: Both the questionnaires are equally effective, the newer one providing more insight however few items maybe irrelevant in Indian context.

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Tonsillectomy is a common surgical procedure often done by otolaryngologist in his/her routine surgical practice. Transient facial nerve palsy is an extremely rare complication of tonsillectomy. The cause of the facial nerve palsy may be due to infiltration of local anesthetic agent into parapharyngeal space and affecting facial nerve. Infiltration of local anesthetic solution into the peritonsillar tissue is commonly used for reduction of pain, although the benefit and risk of complication of this technique have not yet been well established. Here, we presented a rare incidence of facial nerve palsy seen in a 14-year-old boy who underwent tonsillectomy under general anesthesia with local infiltration of bupivacaine at peritonsillar space. The facial nerve palsy was completely recovered by conservative treatment.

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Introduction: Nasal septal deviation is a common diagnosis made by an otorhinolaryngologist, and septoplasty or submucous resection is among the most common daycare procedures practiced in the clinic. Aims and Objectives: The aim of this study was to assess clinically if at all, there is any change in the symptoms of a person post an isolated septal surgery without dealing with the external contour and cosmetic appeal. Materials and Methods: One hundred patients with complaints of nasal obstruction, trouble breathing through the nose, and headache were selected for the study. The initial preoperative assessment was done based on a symptomatic score (Nasal Obstruction Symptom Evaluation Scale [NOSE]). The presence of a septal deviation (cartilaginous or bony) was confirmed with a computed tomography of the paranasal sinuses and a diagnostic nasal endoscopy. Surgery was then performed to correct the pathology based on the location of the deviation. The postoperative assessment was done after 12 weeks based on the NOSE Scale. The results were analyzed and documented. Observations and Results: It was found that the symptomatic picture was better post surgery. Conclusion: The conclusion obtained from the study was that septoplasty and submucous resection as isolated surgical procedures are still relevant in today's world for symptomatic betterment and a healthier lifestyle.

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Background: The spinal accessory nerve (SAN) may damage during its dissection from the sternocleidomastoid (SCM) muscle during modified neck dissection type II due to their intimate relation. Routinely, it is dissected from the anterior aspect of the SCM. The aim of this study is to describe and simplify the safer dissection of the SAN from the SCM muscle. Objectives: We proposed a different method of dissection describing it to be posterior approach. Materials and Methods: Posterior dissection of SAN was done as routine. Conclusion: Although more studies are required to depict the superiority of one over another, we found this method to be easier and time-saving approach.

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Objective: This study aimed to evaluate the etiology, clinical profile, morbidity, diagnosis, and management of vertigo among elderly patients at a tertiary care teaching hospital of Eastern India. Materials and Methods: Seventy-two elderly patients were diagnosed as cases of peripheral vertigo above the age of 60 years enrolled in this study. The detailed etiology, clinical presentations, diagnostic methods, and treatment were assessed. Results: The most common peripheral vestibular disorders were benign peripheral paroxysmal positional vertigo (38.38%), idiopathic vestibulopathy (9.72%), migraine-related vertigo/migraine vestibulopathy (26.38%), Meniere's disease (5.55%), and acute vestibular neuritis (6.94%). Diabetes mellitus is a common systemic disorder associated with elderly vertigo patient. Mental disorders such as anxiety (18.05%), depression (15.27%), and phobia (12.5%) were seen in this study among elderly vertigo patients. Conclusion: This retrospective study revealed that 72 of elderly patients had been diagnosed with peripheral vertigo. The majority of vertigo patients are of benign paroxysmal positional vertigo with unilateral horizontal canal involvement among elderly patients in this study, followed by migrainous vestibulopathy, idiopathic vestibulopathy, and vestibular neuritis. Proper diagnosis and management help to make a better and quality life in elderly patients suffering with vertigo.

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Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for proper management of the patient. Aims and Objectives: To evaluate the clinical and radiological features of thyroid nodule with thyroid surgery. Materials and Methods: A total of 60 patients were included with more than 15 years of age presented with thyroid nodule. Results: Fifty three patients were females and seven were males with goitre duration of 6-60 months and presented with progressive increase in the size of the goitre. After clinical evaluation majority of patients were diagnosed as STN. According to ultrasonography, 58 patients were diagnosed as benign lesions while 2 patients were diagnosed with malignant lesions. According to FNAC, maximum number of patients i.e., 37 were diagnosed with colloid goitre while 2 patients had malignant lesions. On histopathological examination, 58 patients were diagnosed with benign lesions while 2 were diagnosed with malignant lesions. USG findings were correlated with thyroid surgery, Among 60 patients of thyroid nodule. 56 patients underwent hemi thyroidectomy.in which 34 were right thyroidectomy and 22 were left thyroidectomy and 4 patients underwent total thyroidectomy. One patient of total thyroidectomy was develop recurrent laryngeal nerve palsy. Conclusion: USG and FNAC has been shown to be more sensitive, specific and accurate than either technique alone but high resolution USG has important and cost effective investigation to decide the extent and type of surgery of thyroid nodules.

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Plasma cell disorder spectrum ranges from the benign plasma cell granuloma to malignant multiple myeloma characterized by the monoclonal proliferation of plasma cells. Multiple myeloma with temporal bone involvement is a rare entity and may present with nonspecific otological symptoms similar to chronic ear disease leading to a diagnostic challenge. Suspicion of multiple myeloma involving temporal bone primarily is difficult, and most of the cases are diagnosed after initial surgical excision. The differential diagnosis includes temporal bone carcinoma and glomus tumor due to similar radiological features. The final diagnosis is, however, made by the histopathological and immunohistochemical analysis. The mainstay of treatment of multiple myeloma is chemotherapy; however, surgical excision of the lesion is warranted in cases of pressure symptoms and intracranial involvement. We present a case who presented with ear canal mass, facial palsy, and cerebellar symptoms and was diagnosed to be a case of multiple myeloma with temporal bone involvement and was treated successfully. He is on regular follow-up for 1 year and remains in complete remission.

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Introduction: Congenital aural atresia (CAA) is an abnormality of the external ear along with hypoplasia or aplasia of the external auditory canal. Surgery of aural atresia is not only challenging but also has not been accepted by the surgeons. Many surgeons hesitate to undertake the repair due to inadequate hearing outcome and probability of stenosis of the new canal. This report presents the authors' experience of surgical treatment of aural atresia. Materials and Methods: A retrospective analysis of 31 cases of CAA operated during 2002–2018 in a tertiary referral center was performed. Unilateral atresia was more common. A combined anterior and posterior approach was employed in all the cases. Postoperatively, the patients were evaluated for hearing improvement and any sequelae of surgery at varying period up to 3 months. Results: Twenty-eight patients underwent surgery after exclusion of three patients due to diploic mastoids. A postoperative air-bone closure of >25 dB was achieved in 15 out of 28 patients. Five patients had air-bone closure of 15–25 dB. Only 8 patients did not have any hearing improvement. Meatal stenosis occurred in 2 patients. There were no other complications. Conclusions: Patients with CAA of moderate grade favorable radiological findings may benefit with surgery for better hearing outcomes. Bone-anchored hearing devices can be advised if the surgery is not feasible, particularly in high-grade atresia and unfavorable radiology.

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Context: Deep neck space infection is a potentially morbid condition characterized by pus collection in various potential and true spaces of the neck. With this study, we attempt to highlight, the changes in etiological factors in the current scenario, and management protocols for deep neck space infections. Furthermore, we studied the prevalence of antibiotic resistance in isolated microorganisms. Aims: To study the etiology, antibiotic sensitivity pattern, and management of deep neck space infections in adults and pediatric patients. Settings and Design: A retrospective analysis of patients undergoing surgical management of deep neck space infections at a tertiary care institute in India. Subjects and Methods: Analysis of records of 222 patients who underwent surgical management for deep neck space infections was done. All the patients received empirical antibiotic therapy within 30 min of hospital admission. The patients treated with conservative management were excluded from the study. Cultures and antibiotic sensitivities were obtained for patients undergoing surgical management. Results: Dental infection (52%) was the most common predisposing factor for deep neck space infections in adults followed by diabetes mellitus (28.2%). Multispace involvement was the most common presentation followed by parapharyngeal space involvement. The majority of the cultures were sterile (42.6%). The most common pathogen on cultures was Staphylococcus aureus (13.1% in adults and 47.4% in pediatric age group). The incidence of methicillin-resistant S. aureus (MRSA) was 22.7%, which was lower than what has been observed in the previous studies. Klebsiella pneumoniae isolates were found to have high incidence of resistance to cefotaxime (50%), cefepime (38.5%), and ceftazidime (75%). Complications were seen in 4.5% (n = 10) of patients with an overall mortality of 0.9% (n = 2). Conclusions: In view of comparatively lower incidence of MRSA, combination of amoxicillin-clavulanic acid along with clindamycin is a reasonable first-line antibiotic therapy for deep neck space infections. In patients with diabetes, amikacin or piperacillin-tazobactam can be added to the regime, as there is a higher incidence of infection by K. pneumoniae. Surgical management remains the mainstay of treatment and is associated with improved outcome.

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Aim: The aim of this study was to assess the benefits, impact, and efficacy of the adenotonsillectomy (AT) or tonsillectomy or adenoidectomy on quality of life among pediatric patients with chronic tonsillitis or adenotonsillar hypertrophy. Materials and Methods: This was an observational and retrospective study done among children who had undergone AT, tonsillectomy, and adenoidectomy between the ages of 3 years and 16 years during December 2015 to November 2018. Patients were asked by questionnaire for comparing the symptoms before and after 3 months of surgery. Results: There were 220 children who had undergone AT, tonsillectomy, and adenoidectomy. There were 122 male and 98 female children. The age of the children ranged from 3 to 16 years. The mean age of the children was 6.8 years. The mean duration of the clinical symptoms was 2.8 years. The mean attacks of tonsillitis per year, absent days from school, frequency of doctor visits were reduced postoperatively. There was a significant increase in quality of life after AT or tonsillectomy, which was confirmed by statistically validation (P < 0.005) in Student's t-test. Conclusion: AT, tonsillectomy, and adenoidectomy are commonly performed surgical procedures among pediatric patients. All the surgeries are considered as elective procedure often performed in day-care unit where children come by ambulatory, operated, and discharged on the same day of the surgery except if any complications.

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Thyroglossal duct cyst (TGDC) is the most common congenital aberration of the thyroid gland. On the contrary, TGDC malignancies are rare events constituting <1% of all cases of thyroid carcinoma reported in the world. The rarity of the lesion precludes the formulation of clear guidelines and makes management decisions difficult. We describe a case of a young male who presented with a midline neck swelling and underwent radical Sistrunk's procedure and total thyroidectomy for primary papillary carcinoma in a TGDC. The need of total thyroidectomy in high-risk cases needs clinical suspicion and careful consideration of this differential.

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Background: Adenotonsillar surgeries are the most common otolaryngology procedures in the pediatric age group worldwide. Aims: The aim is to evaluate the prevalence, indications, complications, and postoperative symptoms resolution after adenotonsillectomy in pediatric patients in our center. Settings and Design: A retrospective study was conducted in a tertiary health facility in Kaduna, Nigeria. Methodology: The medical records of all children that had surgical procedures from January 2009 to December 2012 were extracted. A total of 232 pediatric patients had adenotonsillectomy of a total of 312 who underwent surgical procedures over 4 years. Forty-eight patients did not meet criteria for inclusion in this study. Therefore, 184 patients satisfied the inclusion criteria for this study. Data were analyzed descriptively with Statistical Package for Social Sciences version 16. Results: The mean age at the time of surgery was 3.5 ± 2.43 years. There were 102 males and 82 females in a ratio of 1:0.8. The main indications were obstructive, pharyngeal, and otologic symptoms. The duration of follow-up after adenotonsillectomy range from 4 weeks to 6 months, 177 (96.19%) had complete resolution of symptoms after surgery, 7 (3.80%) had an additional treatment for rhinosinusitis. Four patients had immediate mild postoperative bleeding (reactionary hemorrhage). No deaths were recorded within the period under review. Conclusions: Adenotonsillar surgeries are common otolaryngology procedures in our hospital, mainly done on account of obstructive symptoms. They are rewarding procedures in terms of symptoms resolution and safety.

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Background: Rhabdomyosarcoma (RMS) is not uncommon in the head-and-neck region. The nonspecific symptomology mimicking benign or inflammatory lesions result in delayed diagnosis, often in advanced stage, mandating multimodal therapy. Moreover, this delayed diagnosis may contribute to poor outcomes. Objective: The aim of this study is to share our experience in managing RMS affecting head-and-neck region. Materials and Methods: This was a retrospective review of six cases treated at a tertiary care institute. Results: Four cases diagnosed to have RMS of the paranasal sinus, one case involving the temporal bone, and one case with tumor presenting in the nasopharynx underwent treatment. Spinal metastasis was detected in two patients. A 5½-year-old child presenting with RMS temporal bone had the longest period of follow-up. Conclusion: This paper presents a series of six such cases that were treated by the senior author. Embryonal RMS of the temporal bone survived for more than 7 years and is on follow-up. Alveolar variant of RMS has a poor survival of >3 years in our series.

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Context: Deep neck space infections (DNSIs) are unique among infectious diseases for potential life-threatening complications. Its early recognition is therefore challenging and a high index of suspicion is necessary to avoid any delay in treatment. Aims: This study aims to analyze the age, sex, source, nature, associated systemic conditions, neck spaces involved, and the bacteria isolated in patients with DNSIs. Settings and Design: A prospective, descriptive study was conducted in the Department of ENT and HNS, B.P. Koirala Institute of Health Sciences, Dharan, Nepal for a period of 2 years from August 2014 to July 2016. Subjects and Methods: All patients with DNSI who required hospitalization were included, whereas those with superficial skin soft-tissue infections, infections due to traumatic or surgical wounds or tumors were excluded. Statistical Analysis Used: The data were recorded on a pro forma and analyzed using Microsoft Excel 2007 (Microsoft, WA, USA). Results: Out of the 76 patients, 25 patients were >50 years of age (32.89%). Male: female ratio was 1:1.17. The most common source was dental infection occurring in 32 cases (42%). Diabetes mellitus was the most common associated systemic condition (4 cases). Submandibular and peritonsillar spaces were most commonly involved. A sterile culture was seen in the majority (18/32). Staphylococcus aureus and Escheria coli were the predominant bacteria isolated. Conclusions: DNSI is a common condition in the elderly populations. Odontogenic infection and diabetes mellitus are the predisposing factors. S. aureus and E. coli are the common causative agents.

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Osteoclastoma or giant cell tumor is an uncommon neoplasm of the bone. Common sites for osteoclastomas are long bones. Osteoclastoma of the craniofacial bones is extremely rare clinical entity. Here, we are reporting a case of osteoclastoma originating from the left maxilla presenting with swelling at the left nasolabial area with nasal obstruction. He had undergone complete excision of the tumor under general anesthesia. During the postoperative period, the patient did well without any evidence of recurrence or metastasis for 1-year follow-up.

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Facial nerve paralysis is the most severe form of cranial neuropathy that causes facial deformity. Late-onset or delayed facial nerve palsy is uncommon following tympanomastoid surgery, although it can occur up to 2 weeks following the procedure. Although pinpointing the specific reason for delayed facial nerve paralysis following tympanomastoid surgery is complex, several variables such as facial nerve injury and/or viral reactivation can play a role. Late facial nerve paralysis after tympanomastoid surgery is caused by exposure of the facial nerve and fallopian canal dehiscence. Late facial nerve paralysis may be produced by viral reactivation and damage to the chorda tympani nerve. This study aims to look at the prevalence, etiology, clinical signs, diagnosis, and current treatment options for delayed facial nerve paralysis following tympanomastoid surgery. The exact cause of delayed facial nerve paralysis after tympanomastoid surgery has significant consequences for therapy and prognosis. The use of steroid and antiviral drugs is helpful for the treatment of the delayed facial nerve paralysis due to viral reactivation. The overall prognosis of the delayed facial nerve paralysis following tympanomastoid operation is good. This article discusses the prevalence, etiopathogenesis, clinical features, diagnosis, and present treatment of late/delayed facial nerve palsy following the tympanomastoid operation.

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