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.

Introduction: Allergic rhinitis is a common chronic inflammatory condition affecting 10 to40

Pleomorphic adenoma is a benign neoplasm commonly found in the salivary glands, but its occurrence in the nasal septum is rare. Nasal cavity pleomorphic adenomas make up 0.4

Allergic rhinitis (AR) impairs quality of life, with intranasal corticosteroids like fluticasone furoate as standard of care (SOC). Individualised homeopathic medicines (IHMs) are increasingly used as adjuncts, but robust evidence is limited. This study evaluates whether an IHM combined with SOC improves clinical outcomes compared with SOC alone in moderate to severe AR.In a randomized, open-label, controlled trial, 210 adults with AR (Total Nasal Symptom Score [TNSS] ≥ 6) were assigned 1:1 to SOC or SOC + IHM for a 12-week treatment phase, followed by a 6-week observational follow-up phase. Primary outcome was TNSS; secondary outcomes included Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Visual Analogue Scale (VAS). Outcomes were assessed at baseline, 4, 12 and 18 weeks using repeated-measures analysis of variance (RM-ANOVA) and t-tests in an intention-to-treat analysis.Both groups showed significant within-group TNSS reductions at 4 and 12 weeks (all p < 0.001), with no between-group differences (p > 0.99). At 18 weeks, when no treatment was administered, SOC + IHM had lower TNSS (1.44 ± 1.00) than SOC (6.48 ± 1.71, p < 0.001), with similar trends for Mini-RQLQ (0.88 ± 0.31 vs. 2.24 ± 0.42, p < 0.001) and VAS (2.04 ± 0.84 vs. 6.35 ± 1.38, p < 0.001). RM-ANOVA showed no Group × Time interaction at 12 weeks (TNSS: p = 0.146, partial η2 = 0.009), but significant interactions at 18 weeks (TNSS: p < 0.001, partial η2 = 0.738). Dropout was minimal (<5%). No serious adverse events were reported.Adding an IHM to SOC did not enhance clinical outcomes during the 12-week treatment but significantly better symptoms control and quality of life at 18 weeks, suggesting a sustained benefit for AR relapse. These findings support IHMs as potential adjunct for long-term AR management, warranting further investigation.

Head and neck squamous cell carcinoma (SCC) encompasses various cancers from the upper aerodigestive tract. Initial presentation often includes regional nodal involvement (40% in stage IVA or B) and distant metastases (up to 10%). Facial edema is a frequent clinical issue with multiple causes, such as allergic reactions, trauma, venous thrombosis, infections, and both benign and malignant conditions. An extremely rare condition is tumor thrombosis of the internal jugular vein (IJV), typically reported in differentiated thyroid cancer cases. We present a diagnosed case of SCC of the left lower alveolus in a 54-year-old female who presented with diffuse facial swelling and stridor two years post-diagnosis. Further evaluation through clinical examination and imaging studies revealed partial thrombosis of the right IJV. The patient underwent an emergency tracheostomy and was treated with intravenous heparin, which effectively managed the local symptoms. This case report highlights the clinical features, diagnostic methods, treatment modalities, and favorable prognosis associated with the long-term effects of untreated head and neck cancers.

Background In the neurosurgical population, opioids may cause respiratory depression, leading to hypercapnia, increased cerebral blood flow (CBF), and ultimately increased intracranial pressure (ICP), which can mask early signs of intracranial complications and delayed emergence. This study was designed to compare perioperative hemodynamic stability, analgesia, and recovery parameters in opioid-based (fentanyl) general anesthesia versus opioid-sparing (dexmedetomidine) general anesthesia in patients undergoing glioma surgeries. Methodology This prospective observational comparative study compared 52 patients in two groups. Twenty-six (50%) patients in group F received Inj. fentanyl IV (intravenous; bolus 2 mcg/kg 10 minutes before induction and then infusion 1 mcg/kg/hour till 30 minutes before skin closure), whereas 26 (50%) patients in group D received Inj. dexmedetomidine IV (0.5 mcg/kg infusion 10 minutes before induction and then maintenance with a 0.5 mcg/kg/hour infusion till 30 minutes before skin closure). Perioperative heart rate (HR), mean arterial pressure (MAP), Numerical Rating Scale for Pain (NRS) assessment and postoperative emergence time, modified Aldrete score, patient satisfaction, and surgeon satisfaction score were estimated and compared in both groups. Results The mean HR was less in group D compared to group F at following time points - 10 minutes after infusion (P = 0.006), laryngoscopy and intubation (P = 0.003), pinning of the skull (P < 0.001), one hour after dura opening (P = 0.007), two hours after dura opening (P = 0.006), five minutes after extubation (P < 0.001), and 30 minutes after extubation (P = 0.011). MAP was lower in group D compared to group F at the following time intervals: 10 minutes after infusion (P = 0.008), five minutes after extubation (P = 0.007), 30 minutes after extubation (P < 0.001), and one hour after extubation (P = 0.023). A significant decrease in emergence time in group D compared to group F (P < 0.001) was noted. NRS was lower in group D at eight hours (P = 0.005) and 12 hours (P < 0.001) post-extubation. Conclusions Dexmedetomidine can be used as an alternative to fentanyl in terms of perioperative hemodynamic stability, perioperative analgesia, smooth early recovery from anesthesia, patient satisfaction, and surgeon satisfaction.

Background Smoking is a major global health issue that is linked to various health conditions, including hearing loss and reduced salivary flow. This study aims to explore the relationship between smoking, hearing loss, and salivary flow rate. Methods This cross-sectional study was conducted over two months at a tertiary healthcare institute in Central India, involving 100 participants (50 smokers and 50 non-smokers) aged 18-55 years. Hearing status was assessed using audiometry, and the salivary flow rate was measured. Statistical analyses were performed using SPSS version 21 (IBM Corp., Armonk, NY, US). Results Smokers had a significantly higher prevalence of hearing loss (40%) compared to non-smokers (10%). The salivary flow rate was significantly lower in smokers (mean 0.5540 ml/min) than in non-smokers (mean 0.9240 ml/min). However, no significant correlation was found between the duration and frequency of smoking with hearing loss or salivary flow rate. Conclusion Smoking significantly impacts both hearing and salivary flow rate, hence smokers show a higher risk of hearing loss and reduced salivary flow rate. Early hearing screenings and preventive measures are recommended for smokers. Further research with larger sample sizes is needed to explore the long-term effects of smoking on these health parameters.

Objective Hearing loss as a comorbidity of type 2 diabetes mellitus (type 2 DM) is frequently overlooked by patients and healthcare professionals because of a lack of awareness. This cross-sectional study aims to investigate the impact of DM on sensorineural hearing loss (SNHL) in the population of Eastern India. The primary objectives are to assess the prevalence and severity of SNHL among individuals with DM, explore demographic and clinical factors associated with hearing impairment, and contribute valuable insights to the understanding of this relationship in a specific regional context. Methods An institutional-based cross-sectional study was conducted on 198 patients with type 2 DM. Of these, 46 patients were excluded based on exclusion criteria. All patients underwent detailed demographic and clinical assessments, including glycemic control, DM duration, and associated complications. Pure tone audiometry was used to evaluate hearing thresholds. Otoacoustic emission testing was performed to assess cochlear dysfunction. Results A high prevalence of SNHL (70.4%) was observed among the 152 participants meeting the inclusion criteria. Females exhibited a higher prevalence than males, and most participants experienced mild SNHL. Rural residence, lower socioeconomic status, and poor glycemic control were associated with increased SNHL. Significant associations were found between hearing loss severity and DM duration, glycosylated hemoglobin (HbA1c) levels, and complications. Among complications, a strong association was noted with diabetic neuropathy. No significant association was observed with the presence or absence of otoacoustic-emission. Conclusion This study reveals a substantial impact of DM on SNHL in Eastern India, emphasizing the importance of routine hearing assessments in diabetic populations. The findings contribute to regional understanding and have implications for targeted healthcare interventions and preventive strategies.

INTRODUCTION:Malignancy of the nose and paranasal sinuses is a highly heterogeneous tumor group that arises from various cell types commonly seen in the fifth to sixth decades of life, with twice as much commonness in males. Patients present with varied clinical presentations like nasal obstruction, facial swelling, orbital complications, etc. Squamous cell carcinoma and adenocarcinoma are the most common variant. Surgery followed by adjuvant chemo or radiotherapy is the treatment of choice.METHODS:The study was undertaken in the Department of Otorhinolaryngology All India Institute of Medical Sciences, Bhopal, India, from 2021 to 2023. It was a retrospective study in which patients diagnosed and underwent treatment in the last 2 years were enrolled. Data were retrieved from the medical record department and surgical registry. Twenty-eight patients were recruited for the study. Detailed history, clinical examination, imaging findings, surgical plans, postoperative adjuvant therapy details, and histopathological findings were recorded.RESULTS:There were 18 (64.2%) males and 10 (35.8%) females, with a male-to-female ratio of 1.8: 1. The mean age of patients was 50.5 years. Facial swelling was the most frequent symptom (n=15, 54%). Twenty-one (75%) patients use chewable tobacco, while sixteen (57%) are smokers. All our patients belong to the lower socioeconomic group. Endoscopic resection was done in 15 (62.5%) patients, and combined open and endoscopic approaches were used in 9 (37.5%) patients. The most common histological variant was squamous cell carcinoma (n=8, 28%).CONCLUSION:Malignancy of the nose and paranasal sinus is very rare. They presented with varied masked clinical presentations of benign diseases. Early identification and high clinical suspicion, along with imaging studies, are pivotal in managing malignancy of the nose and paranasal sinuses.

Introduction: Tracheostomy is a very commonly performed surgical procedure in patients of prolonged ventilation and in carcinoma larynx patients presenting with stridor. Tube fracture at the neck and its displacement into the bronchus can be fatal. A 65-year-old presented with respiratory distress with alleged history of aspiration of br Case Report: oken tracheostomy tube while cleaning. Patient had poor follow up after tracheostomy and last tube change was done 6 months back. The foreign body was localized in the left main bronchus embedded in the bronchial mucosa and was removed via a rigid bronchoscope under a short general anesthesia without intubation. There was no signicant injury of the bronchial mucosa. Proper tracheostomy tube care and tube change Conclusion: at regular intervals is to be followed strictly to avoid complications like dislodgement in bronchus and airway compromise.

Tracheostomy is a life-saving procedure in which an opening is created in the anterior wall of the trachea. Different skin incision types are administered in tracheostomy procedures, predominantly vertical and horizontal. Various literature on the skin incision types in tracheostomy had contradictory findings, with different studies observing that one skin incision type had better outcomes than its counterpart. Hence the objective of this study was to compare the outcomes associated with vertical and horizontal skin incisions in patients undergoing tracheostomy. Method The present study assessed the outcome measures between the two incision types (vertical and horizontal) in tracheostomy. A prospective longitudinal study was done based on an academic tertiary hospital in Bhopal, Madhya Pradesh. Participants above 18 years who underwent tracheostomy were enrolled in the study and followed up over six months during intraoperative, immediate, within seven days, and long-term periods. Result In intraoperative complications, bleeding was most common (n = 15, 16.7%), followed by passage of tube into false tract (n = 6, 6.7%) and saturation drop (n = 2, 2.2%). Immediate complications comprised T -tube blockage (n = 4, 4.4%) and bleeding (n = 1, 1.1%). Complications within seven days occurred only in the horizontal group in which stomal site ulceration (n = 4, 6.7%) and delayed bleeding (n = 2, 3.3%) was seen, and one participant had unintended decannulation. In the long term, complications observed were stomal granulation (n = 9, 19.1%), dysphagia (n = 7, 14.9%), and unintended decannulation (n = 4, 8.5%). Conclusion In the current study, the most common intraoperative complication was bleeding, the immediate complication was tube dislodgement, and tracheostomy site ulcer was the most common complication within seven days, similar to the literature findings.

Abstract BACKGROUND. Foreign bodies of paranasal sinuses are very rare in ENT clinical practice. CASE REPORT. We will discuss the case of a 38-year-old gentleman who showed up at our Emergency Room with loss of vision in his left eye following a blast injury. The initial physical examination identified a ruptured globe in the left eye, which caused left-eye blindness. An immediate plain X-ray revealed a metallic object lodged in the left maxillary sinus, reaching up to the left sphenoid sinus. The external approach was used to manage the patient surgically, with no intra- or postoperative complications. CONCLUSION. Inadequate managing of foreign bodies in the paranasal sinuses might result in significant morbidity. They must be removed surgically, either endoscopically or via an external method.

Background: Chronic suppurative otitis media (CSOM) is a prevalent and persistent middle ear condition that not only affects auditory health but also potentially influences various aspects of an individual's life. This study explores the correlation between CSOM, depression, anxiety, and stress, using the 21 -item Depression, Anxiety, and Stress Scale (DASS 21), also assessing quality of life (QoL) using the Chronic Ear Survey (CES) questionnaire. The primary objective of this study was to gather prospective audiological data along with information on both disease -specific quality of life and psychological well-being, utilizing validated measurement instruments. Methods: This cross-sectional study was conducted at a tertiary care center in Central India, involving 182 patients with CSOM. The study included individuals aged 18 years and above diagnosed with CSOM in at least one ear. Patients with a history of psychological disorders, head injury, and those with comorbidities such as diabetes, hypertension, and chronic heart diseases were excluded. Pure tone audiometry was employed for hearing evaluation, while the assessment of psychological well-being utilized the DASS 21 questionnaire. Furthermore, the quality of life was evaluated using the CES tool. Results: From the initial cohort of 182 patients diagnosed with CSOM, 32 were excluded based on predefined criteria, resulting in a final sample of 150 patients. The cohort, with a mean age of 34.3 years, exhibited a predominantly female population (63.3%). Psychological assessments using DASS 21 revealed depression in 22 (14.7%) patients and anxiety in 23 (15.3%) patients. Among those with depression, majority of the participants had mild depression. Similarly, among those with anxiety, the majority were found to be experiencing mild anxiety. Bilateral CSOM demonstrated a higher prevalence of anxiety and depression, establishing a significant association. QoL parameters, assessed by the Chronic Ear Survey, indicated a more adverse impact in bilateral cases across all categories except symptoms. Correlation analysis between psychological well-being, quality of life, and hearing loss severity yielded statistically significant results. Conclusion: CSOM with the symptom of hearing loss can lead to reduced QoL and psychological well-being in the affected individuals. This study highlights the psychological impact of CSOM, particularly in bilateral cases and severe hearing loss. Integrating psychological support into treatment plans is crucial for comprehensive patient care. Regular assessments are essential for guiding timely interventions, ensuring a holistic approach to enhance both quality of life and psychological well-being in individuals affected by CSOM.

A bstract Traumatic brain injury (TBI) is a significant concern in children, with various prognostic methods used, including the neutrophil-to-lymphocyte ratio (NLR). While studies in adults show the usefulness of NLR, limited data exists for children. Physiological differences in pediatric TBI may render adult criteria inapplicable. This systematic review aims to collect evidence from articles on NLR use in pediatric TBI, addressing knowledge gaps and providing insights specific to children. To gather and synthesize information on the use of NLR in prognosticating pediatric brain injuries. Following PRISMA guidelines, we conducted a systematic literature search across PubMed, SCOPUS, Cochrane Library, and ScienceDirect to identify relevant studies on the NLR in pediatric TBI for prognostication. Inclusion criteria comprised randomized controlled trials, prospective, and retrospective studies, while exclusion criteria ruled out case series, reports, editorials, comments, animal studies, and non-English literature. Extracted details included study characteristics, NLR measurement methods, inclusion/exclusion criteria, outcomes, and correlations. Bias was assessed using the revised JBI critical appraisal tool in alignment with study characteristics. This systematic review initially included 20 studies, narrowed down to 7 for qualitative synthesis. Spanning from 2020 to 2023, these studies involved 1462 pediatric patients under 18 years. NLR measurements and outcomes varied across the studies (e.g., GOS, GOS-E peds, GCS, PTA, CT, and PCPCS). Due to variability in reporting and NLR collection times, meta-analysis was not feasible. Individual studies demonstrated NLR correlations with diverse outcomes, and all seven studies had a low risk of bias in quality assessment. NLR shows promise as a predictive marker for pediatric TBI outcomes, but the limited literature with methodological variations underscores the need for prospective studies with standardized protocols. Caution is advised in interpreting NLR values until validated through rigorous research methodologies.

Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive to medical therapy. Voice alterations following thyroid surgery are well-documented and often attributed to recurrent laryngeal nerve dysfunction. However, subtle changes in voice quality can persist despite anatomically intact laryngeal nerves. This study aimed to quantify post-thyroidectomy voice changes in patients with intact laryngeal nerves, focusing on fundamental frequency, first formant frequency, shimmer intensity, and maximum phonation duration. Methodology This cross-sectional study was conducted at a tertiary referral center in central India and focused on post-thyroidectomy patients with normal vocal cord function. Preoperative assessments included laryngeal endoscopy and voice recording using a computer program, with evaluations repeated at one and three months post-surgery. Patients with normal laryngeal endoscopic findings underwent voice analysis and provided feedback on subjective voice changes. The PRAAT version 6.2 software was utilized for voice analysis. Results The study included 41 patients with normal laryngoscopic findings after thyroid surgery, with the majority being female (85.4%) and the average age being 42.4 years. Hemithyroidectomy was performed in 41.4% of patients and total thyroidectomy in 58.6%, with eight patients undergoing central compartment neck dissection. Except for one patient, the majority reported no subjective change in voice following surgery. Objective voice analysis showed statistically significant changes in the one-month postoperative period compared to preoperative values, including a 5.87% decrease in fundamental frequency, a 1.37% decrease in shimmer intensity, and a 6.24% decrease in first formant frequency, along with a 4.35% decrease in maximum phonatory duration. These trends persisted at the three-month postoperative period, although values approached close to preoperative levels. Results revealed statistically significant alterations in voice parameters, particularly fundamental frequency and first formant frequency, with greater values observed in total thyroidectomy patients. Shimmer intensity also exhibited slight changes. Comparison between hemithyroidectomy and total thyroidectomy groups revealed no significant differences in fundamental frequency, first formant frequency, and shimmer. However, maximum phonation duration showed a significantly greater change in the hemithyroidectomy group at both one-month and three-month postoperative intervals. Conclusions This study on post-thyroidectomy patients with normal vocal cord movement revealed significant changes in voice parameters postoperatively, with most patients reporting no subjective voice changes. The findings highlight the importance of objective voice analysis in assessing post-thyroidectomy voice outcomes.

We present a case report of a forty-year-old female who complained of a progressively swelling mass over the right medial canthus for over a decade.The patient experienced waxing and waning swelling with dull aching pain but had no other nasal or visual complaints.Physical examination revealed a 2 x 2cm ill-defined, tender, cystic swelling with erythematous overlying skin and telecanthus.Anterior rhinoscopy indicated bilateral atrophic rhinitis, and contrast-enhanced computed tomography (CT) revealed a non-enhancing expansile lesion involving the right frontoethmoidal sinuses and the orbital space.A diagnosis of right frontoethmoidal mucocele was made, and the patient underwent endoscopic decompression.Intraoperatively, the concha bullosa was found to be continuous with the anterior ethmoid and frontal sinus due to bone erosion.Postoperatively, the patient's symptoms resolved, and nasal endoscopy at the two-month follow-up showed well-healed mucosa.This case highlights the importance of considering mucoceles in concha bullosa and emphasizes the role of CT imaging in surgical planning for these rare presentations.Functional endoscopic sinus surgery with adequate drainage is a preferred treatment option for such cases.

Introduction: Diseases of the nose and paranasal sinuses have a significant impact on the patient's functional and structural aspects. They affect all age groups and both sexes. Due to its proximity to vital structures, diseases of the nose and paranasal sinuses sometimes lead to very grave prognoses. Materials and methods: This was a retrospective study done in one of central India's largest tertiary care centers. We studied 227 cases of sinonasal masses in both the non-neoplastic and neoplastic categories. Clinicopathological characteristics of masses were analyzed with the help of clinical and imaging findings and subsequently confirmed by tissue diagnosis. Results: The mean age of presentation was 45.5 years, with a male-to-female ratio of 1.25:1. Most of our patients were from lower-middle socioeconomic groups with educational qualifications below the 10th standard. Nasal obstruction was the most common symptom. A computed tomography scan was the preferred radiological investigation. Sinonasal undifferentiated carcinoma was the most common variant of malignancy, with a total number of six out of 22 (27%). Conclusion: The evaluation of sinonasal masses should be carried out systematically and meticulously. Since the initial presentation of most of the diseases of the nose and paranasal sinuses is the same, a proper clinical, radiological, and tissue diagnosis should be carried out to avoid causing malignant lesions.

Tuberculosis (TB) is a chronic granulomatous infectious disease with 25% morbidity due to extrapulmonary form. Hence, knowledge about varied presentations of extrapulmonary oropharyngeal type may help in early diagnosis and management in acute as well as chronic settings. This article describes immunocompetent patients' presentation with varied oropharyngeal manifestations and later diagnosed with tuberculous tonsillitis and tuberculous abscesses with Pott's spine. The varied manifestation of oropharyngeal TB, which is supposed to be a chronic condition, may help in early diagnosis in acute and chronic settings.

Cervical necrotizing fasciitis is an immensely progressive, difficult-to-diagnose soft tissue infection of the fascial planes, skin, and subcutaneous tissue. It has marked morbidity and mortality. In this case report, we analyzed the risk factors, laboratory indices, and treatment modalities that affect the outcome of this fatal disease. This is a retrospective case series of cases admitted within a short span of six months between January and June 23. The cases were followed up monthly for three months, and the diagnosis was made on a clinical, pathological, radiological, and histopathological basis. All the cases were managed with neck exploration and aggressive surgical debridement in an emergency department, dressing of the wound with hydrogen peroxide and betadine twice daily, triple broad-spectrum antibiotic therapy for polymicrobial infection, and tight glycemic control. There were no complications, and all the patients survived. We report our cases of cervical necrotizing fasciitis that had similar presentations but varied outcomes. Here, we would like to advocate the importance of immediate management in the form of neck exploration and debridement at the earliest after the diagnosis has been established. Hyperglycemia should be brought under control, and daily aseptic dressing with removal of the slough and source of infection would greatly affect the outcome of this deadly disease.