Introduction: Idiopathic Subjective Tinnitus (IST) is an auditory condition perceived without an external stimulus and lacks identifiable cause which makes it very difficult to treat. The Tinnitus Handicap Inventory (THI) is a validated tool to assess the severity and impact of tinnitus which has been used extensively since it is practically free. This study evaluates the role of THI in monitoring treatment efficacy in IST. Materials and Methods: A prospective observational study was conducted at a rural South Indian hospital involving 100 patients aged 21–60 years with IST of at least one year duration. Patients had audiometry to exclude objective causes. THI scores were recorded pre- and post-treatment (12 weeks) with Caroverine, Tocopherol, Levocarnitine, Tinnitus Retraining Therapy (TRT), and Cognitive Behavioral Therapy (CBT). Observations and Results: The mean pre-treatment THI score was 44.92 (moderate), improving significantly to 15.78 (slight) post-treatment (p<0.01). 64.87% overall symptom improvement was observed. Notably, the symptom of "desperation" improved by 98.71%, while "insecurity" improved by 16.36%. No patients worsened or dropped out during the study. Discussion: The THI demonstrated excellent utility in quantifying symptom severity. Our population showed lower average age and greater occupational noise exposure than usual. The addition of adjunct therapies (TRT, CBT, antioxidants) possibly enhanced outcomes over monotherapy. THI’s ease of use and non-invasiveness make it especially suited for low-resource or community-based settings. Conclusion: THI is a viable, practical tool for diagnosis, grading, and follow-up of IST. Caroverine is an ideal first line drug for the management of IST.
Background: Rhinophyma is a benign slow-progressive nasal skin deformity characterised by hypertrophy of sebaceous gland and connective tissue. It predominantly affects middle-aged and elderly males and can result in significant cosmetic disfigurement and psychological distress. Various treatment modalities have been described, with no single universally accepted approach. Methods: This descriptive case series was conducted at a tertiary care centre in Karnataka between January 2023 and December 2025. Six patients diagnosed with rhinophyma were included in this study. Five patients underwent surgical management, while one opted for conservative medical therapy. Results: The study included five male and one female patient, with a mean age of 49.5 years. All patients treated with surgery showed satisfactory outcomes. The healing duration ranged from 4 weeks to 3 months. No recurrences or major complications were observed during follow-up (3–24 months). Disease progression was stabilized in patient with conservative treatment. Surgical excision or shaving combined with regular postoperative dressings resulted in effective wound healing with minimal scarring. Conclusion: Surgical management of rhinophyma using simple excision or shaving techniques, along with meticulous postoperative care has proven to be a safe, cost-effective, and reliable treatment option. It provides excellent cosmetic results, high patient satisfaction, and minimal recurrence.
Background: Ossiculoplasty is the reconstruction of the middle ear ossicular chain. Hearing improvement largely depends on mechanical stability and bio-compatibility of prosthesis used. Aim and objectives: To evaluate and compare hearing improvement after type III tympanoplasty with ossiculoplasty using septal cartilage and grommet. Methodology: This was a prospective study conducted on 62 Chronic Otitis Media (COM) patients who underwent type III tympanoplasty with ossiculoplasty. Patients in the age group of 18 years to 50 years and with conductive hearing loss of 45 dB to 60 dB with an air-bone (AB) gap of more than 45 dB, were included. Patients were randomly divided into two groups. Group A had ossiculoplasty with septal cartilage while Group B had it with grommet as the prosthesis. The outcome was measured using Pure Tone Audiometry (PTA), in terms of postoperative hearing gain and AB gap reduction at 3 months and 6 months. Results: Mean age of the study population was 34.84±11.396 years, with male-to-female ratio 1: 1.07. Left ear was the most operated one. Major complaints were hearing loss and ear discharge. Squamosal disease was present in 62.9% of patients. Incus was the most involved ear ossicle. Mean PTA in both groups showed significant improvement when compared pre- and postoperatively. A comparison between the two study groups in terms of AB gap reduction and hearing gain pre- and postoperatively didn't reveal any statistically significant differences. Most common postoperative complication was secondary perforation. Extrusion was present in 3 patients of Group B. Conclusion: Grommet can be an effective ossicular prosthesis with hearing outcomes and complications comparable to conventional grafts such as septal cartilage.
Introduction: Acute acoustic trauma implies injury to ear due to explosive blast or impulse noise. It primarily results in sensorineural hearing loss, but also causes tinnitus, earache, ear fullness, unsteadiness or sleep disturbance etc. There is no gold standard treatment protocol which has been found to be convincing. This study was done to compare clinic-audiological recovery in early and late cases following oral steroid therapy. Materials and Methods: A prospective study was conducted with 40 patients of 18 to 45 years of age suffering from Acute acoustic trauma. Patients reporting within 7 days were considered ‘early cases’ (Group A) and those reporting between 8th to 28th day were considered ‘late cases’ (Group B). Following thorough clinical examination, hearing thresholds were recorded before and after treatment with oral prednisolone instituted at 1mg/kg body weight for 7 days tapering over next 7 days. Follow-up audiograms were done on 15th day and 6 months later. Results: Tinnitus, hearing loss, earache, unsteadiness and tympanic membrane perforation were found in 95%, 90%, 60%, 15% and 30% patients respectively. Majority audiogram showed Type II pattern with high frequency loss. Only 5.26% showed dip at 4kHz. Steroid therapy significantly improved air and bone conduction thresholds in both groups, however, inter-group comparison was not significant. Moreover, early reporters showed significantly better resolution of associated autological features than late reporters. Conclusion: Study results underline beneficial effect of oral corticosteroids in the treatment of early as well as late presentation of Acute acoustic trauma.
Introduction: Post-traumatic facial nerve paralysis (FNP) is challenging, often leaving surgeons in a dilemma between conservative management and surgical intervention. This study was done to evaluate the clinical outcome of FNP resulting from temporal bone fracture (TBF). Material and Methods: A prospective observational study was conducted on patients with radiologically confirmed TBF. FNP was identified in 51 cases and graded using House-Brackmann grading system. Results: Of the 69 cases included in the study, 51 patients exhibited FNP. 34 patients were included in immediate onset (21/34 had indeterminate onset) group and 17 patients were included in delayed onset group. All patients received oral corticosteroids initially. Follow-ups were conducted at 15, 30, 90 and 180 days. Seven patients who showed no signs of reinnervation on electromyography at day 30 were advised to undergo surgical intervention. Only three patients opted for facial nerve (FN) decompression, while four declined surgery. At six-month follow-up, 49 patients (including two post-surgical cases) demonstrated following outcomes: 26 patients improved to HB grade I, 15 to grade II, five to grade III, two to grade IV, and one to grade V. Among the three patients who underwent FN decompression, two improved from grade V-IV to grade III. Of four patients who refused surgery, three remained at HB grades IV-V. Over extended follow-up, one patient deteriorated to grade VI by 54 weeks, while the other two improved to grade II by 64 and 70 weeks, respectively. Conclusion: Immediate onset post-traumatic FNP has the potential for spontaneous recovery without surgical decompression.
Introduction : The marginal mandibular branch of the facial nerve is frequently at risk of injury during neck dissection surgery, causing visible cosmetic deformity and functional problems to the patient. The aim of the study was to assess whether there is any difference in incidence of marginal mandibular nerve palsy, level 1b lymph node yield and operating time between patients in whom the nerve is dissected by traditional methods (Hayes Martin) and where the nerve is directly visualised and dissected. Materials and methods: retrospective review of 45 patients (56 neck dissections) of oral cancer undergoing neck dissection as part of their surgery. Results: patients in whom the marginal mandibular nerve is directly visualised and dissected have a statistically significant decreased incidence of post-operative marginal mandibular nerve palsy and higher level 1b lymph node yield than in patients where the nerve is protected by traditional methods, without any significant difference in operating time. Conclusion: directly visualising the marginal mandibular nerve and dissecting it off the surgical field gives better cosmetic and functional results, as also nodal clearance, in patients undergoing neck dissection for oral cancer, without significantly increasing operating time. Keywords: neck dissection; oral cancer; marginal mandibular nerve; Hayes Martin method
Introduction: Salivary gland tumours are rare and heterogeneous neoplasms, accounting for 3–6% of head and neck tumours. Pleomorphic adenoma (PA) is the most common benign tumour and is often suspected clinically because of its typical presentation as a painless, slow-growing swelling. However, several other entities may mimic PA, creating diagnostic challenges. Case Presentation: This case series includes four patients presenting with painless, slow-growing salivary gland swellings: case 1 of the parotid gland, case 2 of the submandibular gland, case 3 of the sublingual gland, and case 4 of the parotid gland, with clinical and imaging features suggestive of pleomorphic adenoma. All patients underwent radiological evaluation, fine-needle aspiration cytology (FNAC), and definitive surgical excision. Cytological interpretation was performed using the Milan System for Reporting Salivary Gland Cytopathology, which gave us the mirage of pleomorphic adenoma in case 1 and salivary gland neoplasm of unknown potential(SUMP) in the remaining three cases, but histopathologically all the four cases were reported differently as case 1 as myoepithelioma, case 2 and 3 as Adenoid cystic carcinoma(AdCC) whose grading was assessed using the MD Anderson grading system and case 4 as Basal cell adenoma. Conclusion: This case series emphasises the diagnostic overlap between pleomorphic adenoma and other salivary gland tumours such as AdCC and myoepithelioma. FNAC and imaging have limitations in distinguishing these entities, and histopathology remains the gold standard for accurate diagnosis and management. Awareness of this overlap is crucial, particularly in submandibular and sublingual gland tumours, where the probability of malignancy is higher.
INTRODUCTIONS Since less than 250 cases of Internal jugular phlebectasia have been reported in the literature, it is a very rare condition which is often misdiagnosed clinically. This case report will contribute significantly to the sparse literature reviews available on this condition. CASE PRESENTATION 4-year-old boy who belonged to low socio-economic strata was having congenital swelling in neck which increased in size on elevating intrathoracic pressure which was further diagnosed to be internal jugular vein phlebectasia .Patient was managed conservatively and was kept under observation with regular monitoring CONCLUSION Neck swelling has several different differential diagnosis depending upon clinical course and characteristics. Phlebectasia though rare should be considered as one of the diagnosis while evaluating a case of neck swelling. Internal jugular phlebectasia is managed conservatively with regular follow up in most cases and surgical intervention is done in cases with complications or for cosmetic reasons
Introduction Obstructive sleep apnoea patients are more likely to develop certain metabolic and endocrine conditions. During pregnancy, progesterone is linked to hyperventilation. These findings imply that progesterone improves airways.An improvement in sleep is seen in postmenopausal women due to oestrogen as demonstrated in a study. Materials and Methods: The study aims to correlate the levels of Oestrogen and Progesterone in Pre and Post menopausal women with OSA, performed in a tertiary care centre for a duration of 2 years, wherein the patients were divided into 2 groups and the STOP BANG score and Anthropometry and hormonal levels measured and correlated with appropriate statistical method. Results: There was a statistically significant correlation between the mean weight, neck circumference, nasopharyngeal, oropharyngeal airway diameters and levels of Oestrogen and Progesterone. Conclusion: It is their synergistic action of progesterone and oestrogen which is responsible for the definitive improvement in patients with symptoms of OSA as identified and demonstrated in the study.
Introduction- Inflammatory myofibroblastic tumour (IMT) is a rare intermediate grade mesenchymal lesion with low metastatic potential and a high propensity for recurrence. Most commonly affected sites are lungs, abdomen and pelvis. Head and neck IMTs account for 5% of all IMTs with IMT of sternocleidomastoid muscle being exceptionally rare. Case report - A 35 year old female presented with a nodular mass lesion over skin in the left infra auricular area. She had a previous history of swelling at the same site with excision done, and histopathological report revealed inflammatory myofibroblastic tumour. Radiological evaluation was suggestive of neoplastic etiology. Intraoperatively mass was seen over the sternocleidomastoid muscle infiltrating overlying skin. Excision of mass was done along with superficial parotidectomy. Histopathological examination revealed ALK positive inflammatory myofibroblastic tumour of sternocleidomastoid infiltrating the superficial parotid gland. Discussion - Inflammatory myofibroblastic tumours are extremely rare in head and neck region and have a tendency to recur. Complete resection is the treatment of choice and histopathological examination with IHC is confirmatory for diagnosis.
Introduction: Tympanoplasty is a procedure aimed at eradicating middle ear disease, repairing a perforated tympanic membrane, and restoring hearing. Endoscopic tympanoplasty offers advantages such as a magnified view and avoidance of larger incisions, but is limited by being a single-handed technique with no depth perception. The two techniques compared were: Conventional Method: Involves an extended Rosen’s incision and raising a Tympanomeatal flap to reach the middle ear. Push Through Technique: Involves no Tympanomeatal flap elevation; a cartilage graft is pushed through the tympanic membrane perforation after filling middle ear with antibiotic soaked gelfoams. The study's aim was to study the difference between the two techniques in terms of operative time, post-operative pain, post-operative complications (granulation formation and canal stenosis) graft take rate, and hearing improvements. Materials and Methods: This was a prospective comparative study of 50 patients undergoing Type I Endoscopic Tympanoplasty. Inclusion Criteria included patients with moderate and small perforations, Type I Tympanoplasty, and tuning fork test/Pure Tone Audiometry results coherent with the tympanic membrane defect. Exclusion Criteria included patients with a discharging ear, tympanoplasty other than Type I, and patients less than 18 years of age. Results and Conclusion: The two techniques yielded similar results in terms of graft uptake rate and post-operative audiometry changes. The push through technique demonstrated clear advantages with less post-operative pain, no incidence of granulation tissue formation, and less operative and recovery time.
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.
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.
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.
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.
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.
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.
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.
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.
Introduction: The importance of knowing the extra pulmonary manifestations of Tuberculosis (TB) in a country like India, which contributes the largest number of cases in the world, is extremely important in every speciality of medicine. The annual incidence is more than 10 million per year, with about 7.5 million newly diagnosed and 10.6 million total diagnosed cases in 2022. In 2022 alone, India accounted for 27% of the global burden of TB. We would like to address a few of these extra pulmonary manifestations, which should be given as much importance as pulmonary TB. Cases: We would like to discuss 3 cases of extrapulmonary TB and the steps that we took for diagnosis of the same. The first case was TB laryngitis, the second one being a chronic retropharyngeal abscess secondary to TB, and the third being lupus vulgaris of the nose. Conclusion: The diagnostic algorithm of TB has been adequately described in NTEP. But to reach an adequate diagnosis, the onus lies on the clinician to recognise the features and symptoms of a case of extra pulmonary TB. The signs and symptoms on simple visual examination, endoscopy and x ray imaging must not be missed and a clinical diagnosis reached with the help of all 3.
