For several years, botulinum toxin (Botox) injection has remained the gold standard therapy in the management of adductor spasmodic dysphonia. However, its limitations including unpredictable voice outcomes, lack of sustained benefit, and the need for repeated injections have prompted exploration of surgical alternatives. Office-based laryngeal surgery has rapidly gained acceptance as a safe and effective modality. In this article, we describe an innovative office-based diode laser therapy technique performed as a transnasal thyroarytenoid myectomy under local anaesthesia for the treatment of adductor spasmodic dysphonia, with a brief review of the literature. The procedure is carried out with the patient seated upright in the office chair. Following topical anaesthesia of the nasal cavity, pharynx, and larynx using 4% lidocaine, a flexible video nasopharyngolaryngoscope with a working channel is introduced transnasally to the level of the vocal folds. Bilateral thyroarytenoid myectomy is then performed using a diode laser fiber passed through the endoscope’s working channel. Voice breaks began to subside by the third week post-procedure, and sustained improvement was observed for one year during follow-up.The objective improvement was based on change in the Voice Handicap Index (VHI-10) score. from VHI- 30 to VHI-12 and a marked reduction in vocal fold hyper adduction on Videolaryngoscopy This novel technique of transnasal office-based diode laser therapy under local anaesthesia appears to be a simple, safe, and cost-effective alternative to Botox injection therapy for the treatment of adductor spasmodic dysphonia.
Craniofacial asymmetry presents significant diagnostic challenges, particularly when associated with syndromic conditions. This case report presents the clinical evaluation and diagnostic approach to craniofacial anomalies through a case study of a 44-year-old male presenting with features consistent with Nager syndrome—a rare acrofacial dysostosis characterized by craniofacial deformities and upper limb anomalies. Clinical and radiological examinations revealed distinct craniofacial abnormalities, including facial asymmetry, micrognathia, maxillary hypoplasia, cleft palate, and limb deformities such as elbow ankylosis and radial hypoplasia. Despite the presence of multiple craniofacial and skeletal anomalies, systemic health parameters were within normal limits, except for elevated random blood glucose levels. This case underscores the importance of a multidisciplinary approach in the diagnosis and management of craniofacial syndromes and highlights the role of dental professionals in identifying such rare conditions. Notably, the patient exhibited normal growth and cognitive development, minimal functional disabilities, and no significant medical dysfunction.
Introduction: The cochlear implant is a medical device placed in the inner ear through surgery. It is used to correct profound sensorineural hearing loss in patients. Objective: To report the results of the first cohort of cochlear implants in Guinea and present future prospects. Methodology: This was a descriptive study with retrospective data collection over 6 months (July – December 2024), conducted at the ENT Department of Donka National Hospital. Results: We recorded 15 cases of cochlear implants performed during three missions in three different countries (8 in Guinea; 5 in Morocco; and 2 in Ivory Cost). The patients included 7 girls and 8 boys. Their average age was 3.13 years. All presented with severe to profound bilateral sensorineural hearing loss, including 11 children with pre-lingual deafness. Cochlear implantation was unilateral in all patients. Device tuning and speech therapy rehabilitation were conducted regularly. Pre- and postoperative therapeutic education was provided to all parents. Results were satisfactory (6-month follow-up), based on speech therapy reports and parental feedback. Factors influencing these satisfactory outcomes included early cochlear implantation, strong parental involvement, and consistent speech therapy follow-up. Conclusion: The emergence of cochlear implantation in Guinea is the result of support from policymakers and partners. Our major future goal is to establish a cochlear implant center in Guinea. Keywords: cochlear implant, results, prospects, guinea
The deep portion of the human temporalis muscle, often overlooked or inconsistently described in classical anatomical texts, has gained increasing attention due to its functional and clinical significance. From early anatomical observations by Eisler1 and Zenker2 to more recent studies by Geers et al.3 and Fuentes et al.,4 this structure has been linked to mandibular movements, lateralization, and potential involvement in neuropathic pain. Despite its importance, significant gaps remain in understanding its precise morphology, innervation, and clinical implications. This Mini Review aims to clarify conflicting perspectives, identify research gaps, and explore potential advancements in the diagnosis and treatment of disorders related to this muscle. To enhance the comprehensibility of current academic debates, the sources of controversies surrounding its role in neuropathic pain and parafunctional disorders are discussed, along with the reasons for divergent findings across different studies.
A naso-labial cyst is also known as a Klestadt cyst. It is also known by many names such as nasolabial cyst, nasal alveolar cyst, nasal vestibule cyst, nasal mucocele and alar cyst. It is a benign, slow-growing, non-odontogenic soft tissue lesion located in the alar region of the nose just below the nasolabial fold. The most common complaints are swelling in the nasolabial fold and nasal obstruction. These cysts are more common in females and are usually found between the ages of 40 and 50. The sub-labial approach and trans-nasal marsupialization are the preferred surgical techniques for cyst removal. There are many theories about what causes the cysts. Here, we present a 14-year-old female patient with a facial nasolabial cyst and share our experience in the diagnosis and treatment of nasolabial cysts.
Artificial intelligence (AI) is increasingly being explored as a tool in the diagnosis and management of vertigo, though its clinical integration remains in the early stages. While these developments hold promise, they also risk overshadowing foundational physiological mechanisms. One of the most underrecognized yet clinically significant contributors to dizziness is middle ear pressure (MEP) asymmetry, particularly in the context of Eustachian tube dysfunction (ETD). This editorial argues for the reintegration of middle ear physiology into both clinical frameworks and the design of AI-based diagnostic tools for vestibular disorders, drawing on a recent case of ground-level alternobaric vertigo (GLAV) and historical clinical evidence. Recognizing and addressing this diagnostic gap is essential for the development of truly patient-centered vertigo care.
Dual sensory impairment (DSI) is the concurrent impairment of hearing and vision. DSI is linked to an increased risk of depression, loneliness, anxiety, social isolation, accelerated cognitive impairment, cognitive decline and dementia. The fear of dementia is huge. However, fear of a particular disease may actually prevent people from seeking a diagnosis.1 In general cancer (34%) and dementia (29%) are the two most feared diseases but for people 65+ years, dementia is the most feared. Therefore, preventing or delaying dementia is extremely important and is highly correlated with early and effective treatment of vision and hearing problems. Unfortunately, these correlations are not well-known or recognized by professionals or the public.2
The case of a persistent VADS inflammation at first non responding to steroid plus antibiotics treatments is discussed. Repeated non targeted antibiotics may elicit resistance as well as coupling with steroids may favor fungal superinfection, mostly if in predisposed subjects. An impromptu treatment must be thoroughly reconsidered when not fully effective. Accurate multisystemic diagnosis requiring thorough clinical evaluation and appropriate interventions must be planned to seek hidden superinfection sites, before worsening of patient conditions.
This paper reviews the existing global stroke guidelines in different world regions in order to determine their differences and the quality of the guidelines. This review reveals that stroke care protocols are much more available and of higher quality in high-income countries (HICs) compared to low- and middle-income countries (LMICs). With stroke remaining one of the leading causes of morbidity and mortality globally, it is crucial to know these variations in order to improve patient’s outcomes and inform healthcare policies.1,2 The study includes a systematic overview and comparison of 21 different guidelines from 21 countries, using a robust methodology which included data from the major health databases and demographic surveillance systems. Using meta-regression tools and the analysis of barriers to the use of evidence-based practices, the authors show the need for countries with limited resources to adapt existing guidelines to the specific context of their country. The findings show that in many low-income countries the challenges in implementing the best stroke rehabilitation practices are the lack of resources and lack of appropriate guidelines, which results in poor quality of care.3–5 Notably, the meta-analysis also highlights the current debates about the appropriateness and accessibility of thrombolysis and recanalization therapies, especially in the context of virtual care models. The use of these protocols is crucial for the best possible treatment results, however, it is often limited by organizational barriers and lack of training among the healthcare staff.6,7 Furthermore, the analysis underscores the need to address the issue of racial and ethnic disparities in stroke treatment, and supports the idea of culturally relevant education to improve knowledge and care delivery.8,9 In conclusion, this comparative meta-analysis is a very useful tool for clinicians and decision-makers who want to improve stroke management across the globe. The study identifies important gaps and supports the adaptation of guidelines, which in turn contribute to the ongoing efforts to reduce inequity and improve stroke care in underprivileged populations.10–12
Nasal rejuvenation is a highly sought-after aesthetic procedure, addressing concerns such as nasal wrinkles, sagging skin, and irregular contours. Non-surgical rhinoplasty has emerged as a transformative alternative to traditional surgical procedures, offering patients non-invasive and minimally invasive options to enhance nasal aesthetics and correct minor imperfections. The non-surgical Rhinoplasty these days is not only limited to dermal fillers but can be combined with other minimally invasive modalities too. The various techniques utilized in non-surgical rhinoplasty are dermal fillers, botulinum toxin (Botox), Hi-Ku threads, and fibroblasting. By understanding these techniques principles, indications, and limitations, practitioners can provide personalized treatment plans to achieve optimal results. This chapter explores the various techniques, including dermal fillers, hiko nose threads, Botox, and fibroblasting, and delves into these advanced techniques, their mechanisms, applications, and outcomes for nasal rejuvenation. Each modality offers distinct advantages, catering to different patient needs while minimizing downtime and risks. Modern non-surgical approaches like fibroblasting, Botox, and thread lifts have revolutionized nasal aesthetic treatments, offering minimally invasive options with effective, natural-looking results. By understanding the nuances of dermal fillers in liquid rhinoplasty, practitioners can help patients achieve enhanced nasal aesthetics with confidence and precision.
In the digital age, earphones have become a ubiquitous tool among young adults, especially medical students, for academic, entertainment, and communication purposes. While their convenience is undeniable, earphone overuse, particularly at high volumes, poses significant risks to both auditory and cognitive health. This opinion article explores the unseen consequences of prolonged earphone use, including auditory complaints such as tinnitus, ear pain, and hearing changes, as well as cognitive and systemic symptoms like headaches, mental fatigue, and reduced concentration. A cross-sectional study conducted among 747 MBBS (Bachelor of Medicine and Bachelor of Surgery) students in Mumbai revealed that nearly 90% reported auditory complaints, while approximately 47% exhibited cognitive symptoms. These findings underscore the urgent need for early intervention from ENT specialists. ENT specialists can play a pivotal role in addressing this emerging health challenge by shifting from a reactive to a preventive approach. This includes routine screenings for hearing health, awareness campaigns promoting safe listening practices, and leveraging technology such as smartphone apps to monitor listening habits. Public health initiatives, including digital hygiene education and peer-led campaigns, are crucial in raising awareness and fostering behavior change among young adults. Given the growing prevalence of earphone-related health issues, it is imperative that ENT specialists adopt a more proactive stance to safeguard the hearing and cognitive well-being of this generation.
Hearing Healthcare is a major issue across the globe. Untreated hearing loss is correlated with anxiety, depression, social isolation, worsening physical health, cognitive decline, decreased communication and more. The most common problem noted among people with self-perceived hearing loss is the inability to understand speech in noise. Nonetheless, the overwhelming percentage of people with hearing loss do not seek help, despite over the counter and prescription-based hearing aid solutions. Access and affordability have been identified as impediments to acquiring hearing solutions. However, in this article we offer often unspoken “real-world” impediments associated with typical hearing aid form factors; stigma and cosmetic concerns. This article introduces the Nuance Audio Glasses solution with a built-in over the counter hearing aid and reviews lab-based results from three clinical pilot studies. Speech in noise results, as well as subjective results from wearers, and the benefits of a cosmetically pleasing and acceptable over the counter hearing aid solution are introduced.
Various approaches have been supported in the treatment of mandible fractures. Variables including number and location of fractures, patient age, status of dentition, overall health and socioeconomic factors may be used to aid in selecting the most appropriate treatment. In adults, multi-fracture cases are typically treated surgically with any combination of maxillomandibular dental fixation and rigid internal fixation. A case is presented here wherein a select patient with multiple mandible fractures was treated with observation alone. Her fractures and treatment course are described along with a brief discussion of the available treatment alternatives and how this option compares.
Hearing Healthcare is a major issue across the globe. Untreated hearing loss is correlated with anxiety, depression, social isolation, worsening physical health, cognitive decline, decreased communication and more. The most common problem noted among people with self-perceived hearing loss is the inability to understand speech in noise. Nonetheless, the overwhelming percentage of people with hearing loss do not seek help, despite over the counter and prescription-based hearing aid solutions. Access and affordability have been identified as impediments to acquiring hearing solutions. However, in this article we offer often unspoken “real-world” impediments associated with typical hearing aid form factors; stigma and cosmetic concerns. This article introduces the Nuance Audio Glasses solution with a built-in over the counter hearing aid and reviews lab-based results from three clinical pilot studies. Speech in noise results, as well as subjective results from wearers, and the benefits of a cosmetically pleasing and acceptable over the counter hearing aid solution are introduced.
A detailed analysis has been conducted for the current Bekesy's travelling wave theory of hearing proclaimed in 1928. Repeatedly complemented, the theory still contains ambiguities, as well as informal and formal fallacies. Common acceptance of the present state of knowledge about hearing and blocking the discussion on this topic hinder learning the truth about hearing. Achievements in numerous scientific disciplines and experimental research by scientific centres worldwide provide grounds for presenting a new vision of hearing.
Nasopharyngeal lymphoid tissues, the adenoids are considered pathological if they cause mechanical blockage of the nasopharyngeal airway, distort or block the eustachian tube orifice leading to various middle ear conditions like serous otitis media, conductive hearing loss, chronic suppurative otitis media etc. They may also be a source of chronic infection. The treatment is primarily surgical for refractory adenoids unresponsive to medical treatment and also their persistence in adolescence and adulthood. Various techniques have been used to remove the adenoids – commonest being curettage.
Sudden Sensorineural Hearing Loss (ISSNHL) is sudden hearing loss, greater than 30 dB in 3 consecutive frequencies, can be accompanied by tinnitus and sometimes vertigo. The highest incidence occurs from the age of 45 between 55 and 65 years. Its etiology is unknown, but there are several hypotheses such as viral, immunoallergic and vascular causes. Its diagnosis should be made in the shortest possible time in order to guide the etiopathogenic possibilities and start treatment as soon as possible. The injection of intratympanic corticosteroids is the treatment of choice in order to achieve the recovery of hearing thresholds.
The author believes that the optimum choice for patients with hearing loss is not the patient pursuing his/her own “do-it-yourself” diagnosis and self-selected treatment option, but rather pursue the audiologist-driven patient-centered approach using the long-held traditional “diagnosis first, treatment second” approach currently used in medicine and healthcare. In a recent research study to determine if significant differences would emerge using these two approaches in the provision of hearing aids, De Sousa, et al.,1 reported equivalent outcomes between hearing aids fit by audiologists, when compared to self-fit Over the Counter (OTC) hearing aids. In their article, the authors provided numerous caveats to help explain the findings. Numerous “traditional” hearing aids can be successfully fit to every appropriate patient depending on factors as etiology; type, magnitude and configuration of hearing loss; desired improvement in aided signal-to-noise ratio; expertise of the provider regarding implementing best practices to address the goals of the patient. To the author, the most significant factor is the expertise (i.e., diagnosis, consultation, recommendation, selection, programming, verification, and validation services) of the provider.
This editorial explores the notion of "within normal limits" (WNL) in tympanometry, focusing on its limitations in identifying conditions such as alternobaric vertigo (AV) and ground-level alternobaric vertigo (GLAV). Tympanometry is a simple diagnostic instrument that measures middle ear (ME) pressure, compliance, ear canal volume, and the width of tympanogram. While WNL ranges are based on average values from the population, they often do not account for individual differences, leading to possible misdiagnoses. Conditions such as AV, caused by asymmetric ME pressure, can show symptoms even when tympanometry results are within normal ranges. The editorial suggests a more thorough diagnostic approach that includes detailed patient histories, dynamic testing methodologies, and additional hearing and balance tests to improve diagnostic accuracy and patient outcomes. Symmetry in tympanometry data is crucial, and the Valsalva maneuver should be avoided due to potential harm. Future research should aim to improve diagnostic criteria and develop personalized approaches to better understand and manage ME issues.
