In oxidative conditions, nitric oxide acts as a free radical and possible biomarker in the tumor process; however, literature shows conflicting results in this regard. This review aims to evaluate salivary nitrite (NO2−) concentrations in patients with cancer. A systematic review was conducted following the PRISMA 2020 protocol, previously registered in the PROSPERO (CRD42024578042). The methodological quality of the studies was assessed using the Newcastle–Ottawa scale and the AXIS tool. For quantitative synthesis, standardized mean differences (SMD) will be evaluated with a 95
Chronic rhinosinusitis (CRS) refractory to medical therapy is commonly managed with functional endoscopic sinus surgery (FESS). Postoperative inflammation, edema, and crusting may impair mucosal healing and surgical outcomes. To compare the clinical outcomes of betamethasone-, ciprofloxacin-, and saline-impregnated nasal packing following FESS. This randomized controlled trial enrolled 90 patients with CRS undergoing FESS, randomly allocated into three groups (n = 30 each). Postoperative mucosal healing was assessed using the Peri-Operative Sinus Endoscopy (POSE) score. Pain was evaluated using a visual analog scale (VAS). One-way ANOVA with Tukey’s post-hoc test was used for intergroup comparisons. Betamethasone-impregnated nasal packing showed significantly improved early mucosal healing with lower POSE scores and reduced postoperative pain (p < 0.001). Post-hoc analysis confirmed betamethasone was significantly superior to both ciprofloxacin and saline at postoperative days 2, 7, and 28 (p < 0.05). Differences were not significant at 6 weeks (p = 0.712). Betamethasone-impregnated nasal packing improves early postoperative outcomes and is an effective adjunct following FESS.
Chronic rhinitis with nasal polyposis (CRSwNP) is a persistent inflammatory disease that persists and often recurs despite systemic corticosteroid therapy. This study aimed to assess whether adding doxycycline to oral corticosteroids provides a better clinical, endoscopic, and inflammatory outcome than oral corticosteroids alone. This prospective randomized comparative study included 64 patients with endoscopically confirmed bilateral nasal polyposis. Patients were randomized into two groups: Group A (oral corticosteroids plus doxycycline) and Group B (oral corticosteroids alone). Outcomes were assessed at baseline, 2nd week, 4th week, and 3rd month using the Sino-Nasal Outcome Test-22 (SNOT-22), visual analogue scale (VAS) symptom scores, endoscopic nasal polyp scores, and absolute eosinophil counts. Statistical analysis was performed using Student’s t-test and repeated-measures ANOVA. Both groups showed significant improvement from baseline. However, Group A had a significantly greater reduction in SNOT-22 scores at all post-treatment intervals (p < 0.05). VAS scores for nasal obstruction, discharge, facial pain/pressure, and hyposmia were significantly lower in Group A at 3 months (p < 0.001). Endoscopic polyp scores and absolute eosinophil counts showed a greater and more sustained reduction in Group A than in Group B. When combined with oral corticosteroids, adjunctive doxycycline improves inflammatory control, reduces polyp size, and relieves symptoms better than corticosteroids alone. For patients with nasal polyposis, this combination offers an efficient and reasonably priced treatment option, especially in settings with limited resources.
School teachers are among the most vocally challenged professional voice user, frequently encountering vocal fatigue, strain, and malfunction as a result of extended and incorrect voice utilization. Timely recognition and understanding of vocal strain signs are essential for preventing voice problems and preserving vocal health. The study aimed to evaluate the extent of vocal fatigue and investigate its association with self- perceptual tools focussing on vocal priorities using Voice Fatigue Index (VFI) and Vocal Priority Questionnaire (VPQ) among teachers. A cross-sectional survey design was employed. Sixty school healthy teachers aged between 22 and 60 years from various school set up participated in the study. All teachers rated the questionnaire containing demographic questions, teaching background, and validated items from the Vocal Fatigue Index and Vocal Priority Questionnaire. Descriptive and inferential statistics were carried out for the data. High occurrence of vocal fatigue symptoms was observed among teachers. Hours of teaching and vocal fatigue demonstrated a significant association between them (χ² = 14.31, p < 0.01). VFI and VPQ scores showed a strong positive correlation (r = 0.66, p < 0.01), revealing teachers with greater vocal fatigue showed importance for vocal attributes like clarity and endurance. The study underscores the necessity for systematic voice screening and preventive voice care programs tailored for teachers. Incorporating vocal hygiene education and regular vocal assessments into institutional wellness protocols can significantly alleviate voice-related issues in the teaching profession.
Subglottic airway obstruction in adults is rare and is often attributed to post-intubation or post-tracheostomy stenosis. Cricoid cartilage abscess is exceptionally uncommon and poses significant diagnostic challenges due to overlapping clinical and endoscopic features. A 45-year-old diabetic male developed progressive dyspnea and hoarseness following tracheostomy for Ludwig’s angina. Initial endoscopic evaluation suggested subglottic stenosis; however, contrast-enhanced computed tomography revealed a cricoid cartilage abscess causing critical airway narrowing. The patient was managed with elective tracheostomy, external surgical drainage of the abscess, and intravenous antibiotics, resulting in complete resolution of the lesion and successful decannulation. Cricoid cartilage abscess is a rare cause of subglottic airway obstruction and may clinically and endoscopically mimic subglottic stenosis. Contrast-enhanced computed tomography is valuable for establishing the diagnosis and delineating the extent of the abscess. Early imaging and timely surgical intervention, combined with appropriate antibiotic therapy, are crucial to prevent progressive airway compromise and achieve successful airway restoration.
Fiberoptic endoscopic evaluation of swallowing (FEES) is an established tool for assessment of oropharyngeal dysphagia. However, variability in procedural technique and interpretation limits interobserver reliability. This study aims to describe a standardized FEES protocol with a structured scoring framework and to evaluate its clinical applicability and reliability. To describe a practical, office-based standardized method of performing Fiberoptic endoscopic evaluation of swallowing using a flexible nasopharyngoscope with structured bolus protocols and validated scoring systems to ensure systematic and reproducible assessment of swallowing function. FEES was performed in an outpatient setting using a flexible nasopharyngoscope introduced trans nasally without sedation. A standardized protocol was followed, including pre-swallow anatomical assessment and secretion grading with sequential administration of food boluses of different consistencies. Swallowing events were evaluated in real time for laryngeal penetration, aspiration, pharyngeal residue and airway protective responses using validated scoring systems. A structured and standardized office-based FEES protocol is a reproducible technique that enables direct visualization of swallowing physiology and early detection of aspiration, including silent events, with integrated scoring that improves reproducibility, enhances clinical decision-making, and may serve as a training tool in dysphagia evaluation.
Postural control in children relies on coordinated visual, vestibular, and somatosensory inputs. The single-leg stance (SLS) test is a quick clinical method to assess static balance, but little is known about SLS performance in children with vestibular disorders, and how age, motion sickness, or handedness may influence results.A cross-sectional observational study was conducted in a pediatric otorhinolaryngology clinic over a 6-week period (July-August 2025). Children aged 3–12 years without visual, orthopedic, or developmental impairments were recruited into either a vestibular case group (n = 12; vestibular dysfunction, chronic ear infection, or unexplained dizziness/motion sickness) or a healthy control group (n = 40). The SLS test was performed under eight conditions: firm floor and foam surface, each with eyes open (EO) and eyes closed (EC), tested on the right and left legs. Time to loss of balance was recorded (maximum 30 s). Data were analyzed using Shapiro-Wilk tests, Mann-Whitney U tests, Spearman correlations, ANCOVA (age-adjusted), and Fisher’s Exact Test where appropriate.Age was significantly correlated with SLS duration in 6/8 conditions (ρ = 0.294–0.503, p < 0.05), with older children performing better. After controlling for age, there were no significant group differences in any condition. Motion sickness was reported in 66.7
The principle behind the surgery for squamosal type of chronic otitis media is exteriorization of Mastoid cavity there by making the ear safe, but sometimes post-operative follow-up is not smooth and there may occur foreign body reaction to the gel-foam with subsequent secondary infection resulting in granulations, adhesions, and fibrosis which further delays the epithelisation of the mastoid cavity leading to irregular mastoid cavity. In order to avoid this foreign body reaction, the same combination of drug in ointment form might prove a better substitute. So, the present study has been performed to compare the outcome of canal wall down mastoidectomy with only ointment vs. gel foam mixed with ear drop of same composition as ointment in terms of status of hearing, graft and mastoid cavity. This was Randomised Controlled trial conducted for a duration of 1 year at a tertiary care teaching hospital on 60 subjects of canal wall down mastoidectomy fulfilling the selection criteria were enrolled in the study. Group 1 comprised of gel-foam soaked with eardrop of antibiotic and steroid whereas in group 2 only ointment of the same composition was used in mastoid cavity. The data was analysed statistically. Both group 1 and 2 were age and gender matched and pre-operative hearing was also homogenous to compare statistically. Outcome of group 2 was better than group 1 in terms of graft uptake, hearing gain, and healing of mastoid cavity at 3 months post-op. Also, post-op sequelae like granulations, synechiae and fibrosis were found to be more in group 1. Use of ointment with antibiotic and steroids composition in middle ear and mastoid cavity showed better results than gel-foam with eardrop of same composition as used in ointment.
Aims: To evaluate the clinical characteristics, management, and outcomes of pediatric orbital complications of sinusitis (OCS), and to explore factors associated with surgical intervention and the presence of an abscess. Materials and methods: A retrospective review was performed of all pediatric patients (< 18 years) admitted to a tertiary referral center with OCS between 2011 and 2022. Demographic, clinical, radiological, laboratory, and treatment data were analyzed. Patients were grouped according to treatment modality (medical vs. surgical) and presence of an abscess. Results: A total of 26 children were included (mean age 7.35 years), and 13 (50
Three-dimensional (3D) modeling is increasingly used to enhance the diagnosis and management of fractures involving the paranasal sinuses and other cranio-maxillofacial structures. To systematically evaluate the application, diagnostic value, and clinical potential of 3D modeling techniques for cranio-maxillofacial fracture assessment. PubMed/MEDLINE and Scopus were searched for peer-reviewed studies published between 2010 and 2024. The review focused on computed tomography (CT) and cone-beam computed tomography (CBCT), automatic and semi-automatic segmentation, machine-learning approaches, and methods for 3D anatomical reconstruction. The reviewed evidence showed that 3D reconstruction improved the visualization of complex fracture lines, small bone fragments, and anatomically challenging regions. Automated segmentation demonstrated high agreement with manual segmentation in several studies, while semi-automatic approaches provided a practical balance between accuracy and computational demands. Three-dimensional models also facilitated preoperative planning, assessment of fracture displacement, and development of patient-specific surgical solutions. However, the available evidence was limited by small datasets, methodological heterogeneity, inconsistent reporting, and the lack of standardized segmentation and validation protocols. Three-dimensional modeling represents a promising adjunct to CT-based diagnosis and surgical planning for paranasal sinus and cranio-maxillofacial fractures. Larger studies, standardized segmentation procedures, and consistent validation criteria are required before these technologies can be routinely implemented in clinical practice.
Head injury is a major cause of morbidity and mortality and is frequently associated with otorhinolaryngological (ENT) manifestations, which are often overlooked during initial trauma management. To study the incidence, pattern, and spectrum of ENT manifestations in patients with head injury and to evaluate the role of radiological investigations in early diagnosis. A prospective observational study was conducted over a period of 1.5 years (December 2022–May 2024) at a tertiary care centre. A total of 100 patients with head injury and ENT manifestations and a Glasgow Coma Scale (GCS) score > 8 were included. Detailed clinical evaluation, ENT examination, audiological assessment, and radiological investigations including X-ray and CT scan were performed. Males predominated the study population (90
In patients with chronic otitis media (COM) with tympanic membrane (TM) perforation, preoperative prediction of ossicular chain integrity is crucial for surgical planning and counseling. The cigarette paper patch test is a simple outpatient procedure that may help estimate ossicular status by assessing reversible conductive hearing loss. To evaluate the association between preoperative cigarette paper patch test response, intraoperative ossicular chain status, and postoperative hearing outcomes in patients undergoing tympanoplasty for chronic otitis media. This was an observational, descriptive longitudinal study conducted in the ENT department of a tertiary care hospital over 6 months. Adult patients with central dry perforations and air-bone (AB) gap > 25 dB were included. After baseline pure tone audiometry (PTA), a cigarette paper patch test was performed, and hearing gain was noted. All patients subsequently underwent tympanoplasty, and intraoperative ossicular chain status was recorded. Postoperative audiometric follow-up was done at 1 month and 6 months. The correlation between patch test hearing improvement and intraoperative ossicular findings was analyzed. Patients demonstrating ≥ 10 dB hearing improvement following the patch test were more likely to have intact ossicular chains intraoperatively, whereas minimal improvement was more commonly associated with ossicular discontinuity or erosion. Mean hearing gain after patch application was 9.9 ± 10.8 dB (95
Percutaneous ethanol injection (PEI) is a minimally invasive treatment for benign cystic thyroid nodules. Although generally considered safe, recurrent laryngeal nerve palsy is a rare complication. We report an 82-year-old man with a large benign right thyroid cyst and pre-existing right vocal cord paralysis who underwent PEI because of high surgical risk. Several hours after the procedure, he developed acute left vocal cord paralysis, resulting in bilateral vocal cord dysfunction and severe airway obstruction requiring emergency endotracheal intubation. Due to persistent airway impairment, right hemithyroidectomy and tracheostomy were subsequently performed. Partial recovery of left vocal cord mobility allowed decannulation one month later. Patients with pre-existing unilateral vocal cord paralysis may be particularly vulnerable to life-threatening airway obstruction following PEI. Careful patient selection, pre-procedural laryngeal assessment, and close post-procedural monitoring should therefore be considered in this high-risk population.
The genus Burkholderia comprises, clinically significant Burkholderia pseudomallei and the Burkholderia cepacia complex which are causative for melioidosis. Both are Gram-negative aerobic bacilli that resides in either water or soil and cause opportunistic infection. Head and neck involvement is uncommon and often mimics tuberculosis or pyogenic infections, resulting in delayed diagnosis and inappropriate treatment. Here we have performed a descriptive observational study among confirmed cases of Burkholderia of the head and neck. Diagnosis was established by microbiological analysis with Gram stain and culture sensitivity of pus. A Computerized tomography scan of the neck was performed as per the signs and symptoms of localized infection. The cases under study included four patients of Bukholderia-pseudomallei and one with Burkholderia-cepacia. All patients were initially suspected to have common bacterial or tuberculosis infections, and two had failed empirical penicillin therapy before referral. They were all compared on various clinical/presenting parameters, and risk factors. All cases were successfully treated with antibiotics with or without a surgical procedure, demonstrating the significance of early diagnosis, with identification of the etiological agent by culture sensitivity and early management. Diagnosis of Burkholderia is challenging as presentation mimics other chronic illnesses such as tuberculosis, along with delay in laboratory confirmation, or underdiagnosis. Involvement of the head and neck is rare and scarcely reported in existing literature. Hence, this study is an attempt to expand the limited literature on head and neck Burkholderia infections from Central India and emphasizes that localized melioidosis may occur even in immunocompetent individuals. Persistent cervical or facial abscesses that fail conventional antibiotic therapy, particularly in tuberculosis endemic region, should prompt microbiological evaluation for Burkholderia species, so as to avoid treatment failure and to reduce morbidity and mortality of melioidosis.
Pierre Robin Sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and upper airway obstruction, often associated with cleft palate. The resulting dynamic airway collapse can cause neonatal respiratory distress, noisy breathing, feeding difficulties, and failure to thrive. Early identification and airway stabilization are essential to prevent hypoxic injury and complications. We present a neonate with PRS who exhibited significant respiratory effort, noisy breathing since birth, and reduced feeding tolerance. Videolaryngostroboscopy revealed glossoptosis, Grade 1 laryngomalacia, and a wide cleft palate. Due to persistent airway compromise despite conservative positioning, a tongue-base adhesion procedure (glossopexy) was performed. The technique involved elevation of lower lip and upper lip mucosal flaps with 5 − 0 Vicryl round body suturing and fixation sutures to anchor the tongue anteriorly, thereby preventing posterior collapse. Postoperatively, the neonate showed improved respiratory effort, was kept intubated for 24 h, and subsequently extubated successfully during gentle weaning. Follow-up endoscopy at 2 weeks demonstrated effective airway patency, and the child was scheduled for cleft palate repair at 6 months. This case highlights the effectiveness and addition of tongue-base adhesion along with supraglottoplasty as a life-saving procedure in PRS with severe glossoptosis unresponsive to conservative measures. An alternative approach is mandibular distraction osteogenesis (MDO), which is increasingly favoured in severe micrognathia. MDO lengthens the mandible gradually, but is a more invasive procedure, requiring specialized equipment, and carries risks such as nerve injury, scarring, and relapse. Tracheostomy, once the standard of care for severe PRS, is now reserved for cases where glossopexy and MDO fail, or where additional airway anomalies coexist. Given its long-term morbidity, it is avoided whenever possible. This case report highlights the effectiveness of successfully managing a neonate with PRS with Tongue base adhesion and supraglttoplasty.
Temporal bone dissection is an essential component of otology surgical training, allowing the development of anatomical knowledge and technical skills. This study aims to evaluate how trainees perceive the transferability of skills in the temporal bone laboratory into actual surgical practice. This analytical, cross-sectional, survey-based study was conducted among 40 participants of a cadaveric temporal bone dissection course at a tertiary hospital. A self-administered 23-item Likert scale questionnaire was used to assess cognitive and spatial understanding, technical skill improvement, clinical skill transferability, and surgical readiness. A total of 40 participants (60
Parathyroid carcinoma (PC) is a rare malignancy often misdiagnosed as parathyroid adenoma due to overlapping biochemical features, including hypercalcemia and elevated parathyroid hormone (PTH) levels. However, PC typically presents with more severe hypercalcemia (> 14 mg/dL), markedly elevated PTH, and a palpable neck mass. Definitive diagnosis requires histopathological evidence of malignancy, such as vascular invasion, perineural invasion, or capsular infiltration. We report a 46-year-old male who presented with an enlarging neck mass initially suspected to be a parathyroid adenoma. Biochemical workup revealed severe hypercalcemia and significantly elevated PTH levels. Imaging and intraoperative findings raised suspicion for malignancy. Histopathological examination confirmed parathyroid carcinoma with involved surgical margins. Due to persistent disease, the patient underwent re-excision and remains under close surveillance. Distinguishing PC from benign parathyroid lesions remains challenging but is critical for appropriate management. The primary treatment is en bloc surgical resection to achieve negative margins and reduce recurrence risk. Adjuvant radiation therapy and chemotherapy have limited roles and are generally reserved for unresectable or recurrent disease.This case underscores the importance of early recognition of PC through comprehensive biochemical, radiological, and pathological assessment. Accurate diagnosis and aggressive initial surgery are essential for optimizing outcomes in this rare but aggressive endocrine malignancy.
Tinnitus is a frequent auditory condition characterized by ringing, buzzing, hissing, chirping, or whistling noises in the ear. Raised fasting serum lipids has been found to play a significant role in development of tinnitus. To estimate lipid profile in patients and to determine the correlation between tinnitus and the levels of serum cholesterol, triglyceride, high density and low-density lipoprotein. After obtaining approval from ethics committee of Vinaya Mission’s Medical College and Hospital, Karaikal, case control study was conducted in 66 patients, 33 cases with subjective tinnitus without hearing loss and 33 control, which comprised of normal individuals. A complete otorhinological examination along with pure tone audiometry, impedance audiometry, HRCT Temporal bone, caloric test and serum lipid profile was done. In our study we found that triglycerides and LDL cholesterol was higher in the study group also the total cholesterol level was more when the duration of symptom was longer and higher grade of THI score was strongly associated with raised total cholesterol, triglyceride and LDL levels. Blood lipid levels may aid with routine clinical diagnosis and prognosis of subjective tinnitus, and patients with dyslipidaemia should get appropriate treatment.
Hypopharyngeal injuries following blunt neck trauma are uncommon and traditionally managed via external neck exploration. We report a rare case of complex pyriform sinus (PFS) managed exclusively through trans-oral microlaryngeal approach. A 21-year-old male presented with respiratory distress and subcutaneous emphysema following blunt neck trauma. Imaging and endoscopy demonstrated a 4-cm laceration of the left pyriform sinus communicating with the prevertebral space. The defect was repaired transorally under microlaryngoscopy using a Lindholm laryngoscope, interrupted 4-0 Monocryl sutures secured with Liga clips, and fibrin glue reinforcement. Oral feeding was resumed after confirmation of an intact repair on post-operative day 7, and the patient recovered without complications. Transoral microlaryngeal repair is a feasible and effective minimally invasive alternative to open surgery in selected hypopharyngeal injuries. It provides excellent visualization, avoids external cervical incisions and scarring, minimizes the risk of pharyngocutaneous fistula, and enables rapid functional recovery. This case demonstrates the potential of this technique as a safe and tissue-preserving option for appropriately selected traumatic pyriform sinus injuries. This case demonstrates that transoral repair of pharyngeal tear using Micro laryngeal surgical techniques for blunt pharyngeal trauma is reliable and can be safely implemented wherever possible.
To describe and compare the clinical, endoscopic, and computed tomography (CT) characteristics of congenital and acquired cholesteatoma in a pediatric population. A descriptive cross-sectional study combining retrospective and prospective data was conducted at the National Otorhinolaryngology Hospital from October 2020 to October 2025. A total of 65 patients aged < 16 years with surgically and histopathologically confirmed cholesteatoma were included, comprising 33 congenital and 32 acquired cases. Demographic, clinical, endoscopic, and CT imaging data were collected and analyzed using descriptive statistics and subgroup comparisons. The study population showed male predominance (70.8
