A woman in her 20s presented with a 3-month history of progressive right-sided otalgia. Otoendoscopic examination revealed a greyish mass occluding more than 75% of the external auditory canal. Biopsy confirmed well-differentiated squamous cell carcinoma. High-resolution CT demonstrated cortical erosions of the anterior and posterior bony external auditory canal with mastoid involvement. The patient underwent two-handed endoscopic lateral temporal bone resection using the Justtach ASM2 endoscope holder, combined with superficial parotidectomy and selective neck dissection. Histopathological examination confirmed complete excision with negative margins. The patient received adjuvant chemoradiation therapy and remains disease-free at follow-up. This case demonstrates the technical feasibility of a two-handed endoscopic approach for temporal bone malignancy resection, though larger studies are needed to establish its efficacy compared with conventional microscopic techniques.

Background Inverted papilloma (IP) is a benign Schneiderian epithelial tumour with a well-recognized potential for recurrence and malignant transformation, most commonly to squamous cell carcinoma (SCC). Carcinoma arising in the nasopharynx after prior IP is exceedingly rare, and distinguishing malignant conversion from a metachronous nasopharyngeal carcinoma (NPC) poses a diagnostic challenge. Case report We report a rare, interesting case of a nasopharyngeal lesion with histopathological features of non-keratinizing SCC in a patient previously treated surgically for sinonasal IP. Conclusion Differentiating malignant transformation of IP from a metachronous malignancy is complex. In this case, the short interval between diagnoses, anatomical separation, and absence of Schneiderian features favour interpretation as a metachronous NPC, highlighting the importance of continued surveillance and prompt evaluation of new symptoms in patients treated for IP.

OBJECTIVE:To evaluate early postoperative patient-reported psychological and quality-of-life outcomes in patients undergoing endoscopic and microscopic tympanoplasty within a prospective non-randomized comparative cohort. METHODS:A prospective comparative study was conducted in 50 adults with mucosal-type chronic otitis media undergoing type I tympanoplasty at two tertiary referral centres (endoscopic, n = 25; microscopic, n = 25). Allocation to surgical approach was determined by institutional operating practice and surgeon assignment rather than randomization. Psychological status and disease-specific quality of life were assessed preoperatively and at outpatient follow-up 2 months postoperatively (±2 weeks) using validated versions of the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Chronic Otitis Media Questionnaire-12 (COMQ-12). Audiological outcomes were evaluated based on air-bone gap (ABG). Postoperative recovery parameters, including duration of hospitalization, return to work, cosmetic satisfaction, and subjective hearing perception, were additionally recorded. Analyses were exploratory and unadjusted. RESULTS:Fifty participants were included. No statistically significant differences were observed between groups in baseline demographic characteristics, preoperative audiological findings, or baseline patient-reported outcome measures. At 2 months, the endoscopic cohort demonstrated lower mean anxiety scores (5.4 ± 1.9 vs 8.6 ± 2.1; p < 0.001), lower depression scores (5.1 ± 1.8 vs 7.9 ± 2.2; p < 0.001), and lower COMQ-12 scores (17.2 ± 4.0 vs 24.6 ± 4.7; p < 0.001) compared with the microscopic cohort. Greater reductions were observed in GAD-7 scores (-9.8 ± 2.3 vs -7.9 ± 2.2; p = 0.005) and COMQ-12 scores (-21.7 ± 4.4 vs -18.6 ± 4.5; p = 0.018), whereas the reduction in PHQ-9 scores did not differ significantly between groups (-11.0 ± 2.3 vs -9.7 ± 2.4; p = 0.06). Audiological improvement as per ABG was comparable between groups (7.8 ± 1.0 vs 7.3 ± 0.9 dB; p = 0.07). Patients managed within the endoscopic group also had shorter hospitalization and higher cosmetic satisfaction scores (both p < 0.001). CONCLUSION:Patients in the endoscopic cohort reported more favorable early psychological and disease-specific quality-of-life outcomes, while short-term audiological improvement, as assessed by air-bone gap closure, was similar between cohorts. Given the non-randomized design, institution-level confounding, absence of detailed disease-specific baseline variables, and short follow-up duration, these findings should be interpreted as associative and exploratory rather than evidence of technique-specific superiority. The study highlights the value of incorporating patient-reported outcome measures alongside conventional audiological assessments in tympanoplasty evaluation.

Chronic rhinosinusitis (CRS) presents with prolonged sinonasal inflammation and may occur with (CRSwNP) or without (CRSsNP) nasal polyps. While creatinine changes have been studied in gastrointestinal polyps, their relation to nasal polyps remains unexplored. This study was undertaken to evaluate whether serum creatinine correlates with presence or severity of nasal polyps using Lund Mackay (LM) computed tomography (CT) score and Lund Kennedy (LK) endoscopy score in CRS patients. A retrospective observational study was conducted on adults diagnosed with chronic rhinosinusitis with and without nasal polyps, who underwent Functional Endoscopic Sinus Surgery (FESS). Clinical history and examination findings, pre-operative diagnostic nasal endoscopy and radiological findings, and intra-operative records were studied in 114 subjects. Median creatinine varied significantly (P< 0.001). In CRSsNP, LK DNE score showed a moderate negative correlation with creatinine (p = 0.010), but no correlation was found in CRSwNP. LM CT score did not correlate with creatinine in either group. Serum creatinine had poor predictive ability for polyps (AUC = 0.54, p = 0.471); at a >= 0.8 mg/dL cutoff, sensitivity was 72% and specificity 40%. No significant correlation could be observed between nasal polyps and serum creatinine levels and hence, creatinine cannot be reliably used to predict severity of nasal polyps.

PURPOSE:Adolescent voice changes can affect self-identity, psychosocial well-being, and overall quality of life, sometimes resulting in social withdrawal and communication challenges. While adaptations of the Voice Handicap Index, such as the Pediatric VHI and CVHI-10, exist for younger populations, research on the applicability of the original VHI in adolescents remains limited. The present study evaluates the VHI in individuals aged 11-15 years by providing normative data, exploring age and gender variations, and comparing scores between adolescents with and without self-perceived pubertal voice changes. METHODS:A cross-sectional study was conducted among 80 adolescents (11-15 years) recruited from schools in South India. After excluding clinically evident laryngeal pathology, eligible participants completed demographic profiling and VHI. Descriptive statistics and group comparisons were performed. RESULTS:Total VHI scores ranged from 0 to 65 (mean 17.6 ± 17.4), with most participants reporting minimal handicap. A small subgroup of adolescents reporting self-perceived pubertal voice change (n=4) had higher mean scores (35.3 ± 13.7) than their peers (16.7 ± 17.2). Differences by age group and sex were not statistically significant. Across the cohort, functional (6.6 ± 6.6) and physical (6.5 ± 6.1) subscales were more affected than the emotional domain (4.3 ± 5.7). CONCLUSION:This preliminary study provides self-reported VHI values in early adolescents, indicating generally mild handicap in healthy individuals but higher perceived impact among those with self-perceived pubertal voice change. While based on a small symptomatic subgroup, the findings offer early insights that can guide future multicenter studies and the development of adolescent-appropriate validated tools.

Introduction: Type 2 diabetes mellitus (T2DM) is associated with multiple systemic complications, including vascular and neuropathic changes that can affect the auditory pathway. These alterations may contribute to hearing loss and difficulty in speech perception, particularly in noisy environments. This study aimed to evaluate speech recognition in noise among patients with T2DM using the Signal-to-Noise Ratio 50 (SNR-50) and to examine its relationship with disease duration and glycemic control. METHODS:An analytical cross-sectional study was conducted at a tertiary care hospital. Ninety subjects aged 30-60 years were recruited, comprising 45 patients with T2DM and 45 age-matched nondiabetic controls. All participants underwent audiological evaluation including pure-tone average (PTA), tympanometry, speech reception threshold (SRT), speech identification score (SIS), uncomfortable loudness level (UCL), and SNR-50 testing. Data were analyzed to assess differences between groups and correlations with diabetes duration and glycemic control (HbA1c levels). RESULTS:PTA values were higher in patients with T2DM compared to controls, indicating worse peripheral hearing. Diabetic patients demonstrated poorer speech perception, confirmed by elevated SRT values. SNR-50 values were significantly impaired in T2DM patients relative to controls. Longer duration of diabetes (>10 years) was associated with reduced SIS and higher PTA and SRT values compared to patients with 5-10 years of disease. A statistically significant positive correlation was observed between SNR-50 and duration of diabetes. While PTA, SRT, and SIS did not show significant variation across HbA1c categories, SNR-50 values worsened significantly with poorer glycemic control. CONCLUSION:T2DM is associated with impaired speech perception and poorer hearing outcomes, with disease duration exerting a cumulative adverse effect. SNR-50 performance was significantly related to glycemic control, suggesting that subtle central auditory dysfunction may coexist with or precede peripheral hearing loss in diabetic patients. Early evaluation of auditory function in T2DM may aid in timely identification and management of communication difficulties. .

Two-handed endoscopic Type 1 tympanoplasty (T1TP) is a minimally invasive surgical technique addressing limitations in precision and dexterity associated with single-handed endoscopic approaches. Despite its potential, comprehensive multicentre evaluations of its outcomes remain limited. To assess the anatomical and functional outcomes of two-handed endoscopic T1TP, considering factors like surgeon experience, perforation characteristics, and graft material selection. This retrospective multicentre study analyzed 550 patients (aged 6–70 years) with mucosal chronic otitis media across five tertiary care centres in India. Data on demographics, perforation size/location, graft material, and pre/postoperative audiometric parameters were collected. Outcomes included graft uptake rates, air-bone gap (ABG) closure, and hearing improvement at 6 and 12 months. Overall graft uptake success rate of 94

Parotid gland tumors represent a significant challenge due to their histological diversity and anatomical complexity. Accurate diagnosis and tailored surgical management are crucial for optimizing outcomes. This study evaluates the diagnostic performance of fine-needle aspiration cytology (FNAC) and investigates postoperative quality of life (QoL) in patients undergoing parotidectomy. A mixed-methods study was conducted over six years (January 2019 to December 2023) across four tertiary care centres in North India. The study included retrospective analyses of FNAC and histopathological outcomes, complemented by prospective evaluations of postoperative complications and QoL using the Parotidectomy Outcome Inventory-8 (POI-8). Statistical analyses assessed diagnostic accuracy and predictors of postoperative outcomes. Among 40 patients, FNAC showed moderate diagnostic performance with a sensitivity of 65.4

Melanocytic nevus (MN) is a common skin lesion; however, its presence in the external auditory canal (EAC) is uncommon. Following previous reports on various treatment approaches, we share our experience with endoscopic resection in managing a case of MN in EAC. A 44-year-old woman presented with prolonged ear blockage with intermittent whitish ear discharge for the past year. Single-handed endoscopic resection is effective in treating a rare external auditory canal melanocytic nevus. This report also illustrates the benefits of endoscopy in early diagnosis and management.

Dizziness and vertigo are among the most frequently reported complaints among patients across various medical and healthcare specialties. Studies have revealed that they are associated with cognitive impairments, particularly in older adults. While vestibular rehabilitation therapy (VRT) alleviates physical symptoms, its effects on cognitive function remain underexplored. Hence, this study aims to assess the impact of VRT on the quality of life and cognitive performance of individuals with chronic dizziness or vertigo. This was a randomized control trial in which 60 participants experienced chronic dizziness or vertigo. The participants were assigned to either the medication-only group receiving betahistine or the VRT + medication group receiving VRT combined with betahistine. Quality of life was measured via the Dizziness Handicap Inventory (DHI). Cognitive performance was assessed via a digit span test, task-switching test, and recording of P300 response. The VRT + Medication group showed significant improvements in cognitive performance, particularly in the digit span and task-switching tests, with reduced P300 response latency and increased amplitude. No significant cognitive changes were observed in the medication-only group. Both groups showed improvement in quality of life, with a greater reduction in DHI scores observed in the VRT + Medication group. VRT combined with medication significantly improves cognitive function and quality of life in individuals with chronic dizziness or vertigo. These findings suggest that VRT not only addresses physical symptoms but also enhances cognitive performance, highlighting its potential as a comprehensive therapeutic approach. The study protocol was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2020/03/023934).

BACKGROUND:While statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve. CASE PRESENTATION:Here we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features. CONCLUSIONS:While benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.

Abstract Background Depression is a common comorbidity among individuals with otolaryngologic disorders, particularly those with longstanding conditions. This study aims at analysing the sociodemographic profile of depressive disorders in patients with chronic otolaryngology symptoms or conditions, and the correlation with PHQ-9 score. Methods A cross-sectional study was conducted on a hundred patients presenting to the outpatient department with chronic otolaryngology symptoms or conditions. They were requested to fill in the PHQ-9 questionnaire, containing questions based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for major depressive disorder (MDD). Results Median age was 39, male: female ratio was 1.17. Nasal obstruction (29%), ear discharge (25%), and headache (17%) were the common presenting complaints. Mean and median PHQ-9 scores were 5.03 and 4 respectively. Seven patients (7%) had MDD, while eleven (11%) had other depressive disorder; 9% of cases were found to have no significant otolaryngologic problem despite presenting with symptoms, two of which were found to have depressive disorder. Thirty-five (35%) and thirty-six (36%) patients had minimal and mild depressive symptoms respectively, while one (1%) had severe depressive symptoms. Statistical significance was noted for the duration of symptoms (p-value 0.005); high statistical significance was found for occupation and otolaryngology diagnosis (p-value < 0.001 each). PHQ-9 score showed statistical significance in comparison with gender and duration of symptoms (p-value 0.046 and 0.005 respectively). Correlation of severity of depressive disorder revealed statistical significance with gender (p-value 0.049) and high statistical significance with duration of symptoms (p-value < 0.001). Conclusion Chronic otolaryngology conditions are associated with significant morbidity, attributable to longstanding disturbing symptoms and prolonged treatment protocols, leading to depression. Nevertheless, depression in chronic otolaryngology disorders may aggravate or overlap the clinical symptoms or may go undetected. Hence it may be worthwhile to evaluate for depressive disorders in chronic patients presenting to otolaryngology.

The COVID-19 pandemic has led to a major public health crisis. Residents entered the frontline in triaging and treating COVID-19 patients, working overtime to meet the growing demand. Surgical practice and educational activities were restricted, thus affecting resident training. There was also a great risk to their mental health. Our study aims to assess the academic impact and quality of life including mental health status among year I, year II and year III otorhinolaryngology residents during the pandemic. A cross-sectional study was conducted among postgraduates and junior residents working in otorhinolaryngology departments in institutions across South India in October 2020. Quality of life, severity of anxiety and depression, and academic impact were assessed using the WHOQOL-BREF, GAD-7, PHQ-8 and Academic impact questionnaires respectively via Google Forms. A total of 303 responses were obtained. Inpatient and outpatient clinical activity were affected irrespective of the year of training. Surgical training was also affected especially among the final-year residents (year III) with a mean score of 4.42. The maximum median WHOQOL-BREF score of 14.66 was found in the social domain and 13.33 in the psychological and social domains in men and women respectively. The majority (43%) of 114 men had mild anxiety, while among women, a slight preponderance (33.9%) of severe anxiety was noted. Most of the residents (75% of men and 66.6% of women) had no symptoms suggestive of depressive disorder, however, 19.3% of the men and 29.6% of the women were found to have major depression. The impact of the pandemic on resident training and mental health has been immense. The study outcome may help residents comprehend and perceive the extent of the same, and explore methods to be equipped and overcome similar circumstances in the future.

Background: Hypertrophy of inferior turbinate (IT) may arise from soft tissue and/or bony enlargement and is most related to inflammatory rhinitis. We aimed to study and compare the histopathological changes in the IT mucosa, submucosa, and bone in chronic rhinosinusitis with (CRSwNP) and without nasal polyps (CRSsNP). Methods: The specimens of the IT in patients who underwent endoscopic sinus surgery and inferior turbinoplasty (ITplasty) were included and studied under the microscope in the high-power field. The changes in the mucosa, submucosa, and bone were studied, graded accordingly, and compared between the 2 groups. Results: In the mucosa, there was no significant difference in the polymorphonuclear neutrophils (PMN) and lymphocytic counts; however, the eosinophilic count in the mucosa was significantly higher in CRSwNP (P = .001). There was no significant difference in basement membrane thickness or subepithelial oedema. However, the lymphocyte count was higher in CRSsNP (P = .003), and the eosinophilic count was higher in CRSwNP (P = .001). The bone did not show inflammation. The significant osteitic changes in the bone were periosteal thickening with osteoblastic activity (P = .016). Conclusion: The mucosa and submucosa had a significant change in CRSwNP related to the eosinophilic infiltrates. In the submucosa, the lymphocyte count was significantly higher in CRSsNP. The osteitic changes seen were limited to periosteal thickening with minimal osteoblastic activity in both groups, but were significantly higher in CRSsNP. Hence, we can resect only the effected mucosa and spare bone during ITplasty in cases of CRSwNP, and IT bone may be partly resected in CRSsNP patients. Cite this article as: Patil V, Sarah Philipose C, Kabekkodu S, et al. A comparative study of histopathology of the inferior turbinate in chronic rhinosinusitis with and without polyp. B-ENT. 2024;20(2):106-111.

BACKGROUND:Though rare, benign lesions that usually do not necessitate active intervention, osteomas of the external auditory canal, can be troublesome when they start to produce mass effect and severe obstruction to the external auditory canal. Even more insidious is the rarer phenomenon of canal wall cholesteatomas, which have been known to cause significant canal erosion and if left unchecked and spontaneous destruction of the adjacent anatomical structures, including the facial nerve, temporomandibular joint, sigmoid sinus, and skull base. The occurrence of both these exceptionally uncommon findings in the same canal is an unusual finding and may point to an undetermined interplay in pathogenesis. CASE PRESENTATION:Here, we describe one such case in a 39-year-old gentleman hailing from South India who presented with complaint of unilateral ear block and decreased hearing and how it was managed. CONCLUSIONS:While osteomas are usually incidental findings in asymptomatic patients, the potential for mass effect and canal obstruction must be kept in mind and patients must be evaluated for development of the more sinister cholesteatoma in the deeper canal.

Vestibular rehabilitation therapy (VRT) is an effective treatment for individuals experiencing imbalance and dizziness, helps to improve the quality of life. Lack of culturally valid questionnaires to assess the outcome from VRT necessitates the development of reliable and culturally valid questionnaire to measure the outcomes of VRT. Hence, the current study aimed to develop a culturally valid and reliable questionnaire for measuring the outcome of VRT in Indian population and to translate it into Malayalam and Kannada. This cross-sectional study was conducted at the department of Audiology and Speech Language Pathology of a tertiary care hospital. The questionnaire was constructed based on thorough literature search of existing questionnaires related to dizziness and vestibular disorders in relevant to the Indian context. Content validity was assessed by expert reviewers using a rating scale, and the questionnaire was translated into two south Indian languages (Malayalam and Kannada). The questionnaire was then administered on 12 patients undergoing VRT to assess its initial validation. The questionnaire was named as ‘Effect of Vestibular Rehabilitation Therapy Questionnaire (EVRT-Q)’, consisted of 25 questions divided into three domains: symptom, function, and emotion. The questionnaire demonstrated good content validity with a Content Validity Index greater than 0.8 for each question in all domains. The questionnaire possesses a high internal consistency when measured using Cronbach’s alpha. Hence, the EVRT-Q appears to be a valid and reliable tool to assess the outcome from VRT in Indian population.

Cystic neck masses in adolescents pose a diagnostic challenge as they be neoplastic or non-neoplastic, congenital, inflammatory, or infectious. Detailed history and examination, anatomical location of the lesion may help narrow down the differential diagnosis of such masses. Cervical thymic cysts contribute to less than 1% cystic lesions in the neck. We present one such case and our management strategy.

Introduction Unilateral facial oedema may occur due to inflammatory, infective, or cystic pathology; patients often seek medical help at an early stage. Case report We report one such case caused mimicking a parotid abscess, caused by dirofilariasis. Conclusion Dirofilariasis is an emerging zoonosis and should be considered a differential diagnosis of atypical facial swelling. It is equally important for clinicians, radiologists, and pathologists to be familiar with the diagnostic characteristics to avoid misdiagnosis.