Background Advanced head and neck squamous cell carcinoma (HNSCC) treatment frequently impacts speech and swallowing, compromising quality of life. This study evaluated short-term voice and swallowing outcomes across five treatment strategies using both patient-reported and objective measures. Methods A cross-sectional analytical study was conducted on 100 patients with stage III–IV HNSCC treated between August 2021 and February 2023. Swallowing was assessed using the Dysphagia Handicap Index (DHI), Swallowing Performance Status (SPS), and videofluoroscopy (VFS); voice was assessed using the Voice Handicap Index (VHI) and acoustic parameters (F0, jitter, shimmer, harmonic-to-noise ratio). Statistical analysis included non-parametric and parametric tests, alongside effect size estimation. Results Surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CCRT) was associated with significant deterioration in both swallowing (median DHI +10 to +11) and voice (median VHI +34 to +39) scores. Objective acoustic changes confirmed worsening in F0, jitter, and shimmer. In contrast, patients treated with definitive CCRT showed improvement in swallowing (median DHI –26; p < 0.001) and stable subjective voice scores, despite acoustic perturbation—highlighting a discordance between perceived and measured function. Palliative CRT showed numerical improvements but was underpowered for statistical comparison. Conclusion Functional outcomes in advanced HNSCC differ by treatment modality. Surgery with adjuvant therapy is associated with early functional decline, while definitive CCRT may offer short-term preservation of swallowing and voice in selected patients. Routine integration of patient-reported and objective assessments is essential to guide rehabilitation and optimize survivorship care.

To assess the audiological and subjective outcomes after bone conduction implant (BCI) surgery. To compare hearing improvement with bone conduction implant in patients with conductive, mixed hearing loss, or single sided deafness with normal hearing in the other ear. Ten patient underwent BCI and were enrolled in this study. Hearing ability before and after surgery was measured using free-field pure-tone audiometry (PTA). Free-field hearing threshold averages (mean at 500, 1000, 2000, 4000 Hz) was used. Quality of life was evaluated with two questionnaires, the Hearing Implant Sound Quality Index-19 (HISQUI-19) and the Speech and Spatial and Qualities of Hearing Scale (SSQ12). Baseline data was collected during a pre-operative visit and compared after surgery. All patients underwent follow-up at tenth day, 1, 3, and 6 month in post operative period. Bone conduction implant showed good audiological outcomes. Outcomes in terms of gain in free-field PTA were analysed using Pearson Chi-square (X2) of 44.755 with a p-value of 0.001 indicating these changes are statistically significant in all ten patients. This suggests a strong association between the period and the audiometric outcomes following implantation. The SSQ12 and HISQUI-19 scores showed statistically significant improvement after surgery. Bone bridge BCI-601 and 602 implant is an effective hearing rehabilitation device. Audiological results and improvement in QOL confirms its efficacy and safety. Patient selection is the key factor for choosing the candidate for bone conduction implant.

Pharyngocutaneous fistula (PCF) is the most frequent complication after total laryngectomy. Videofluoroscopic swallow study (VFSS) is often used to guide postoperative feeding, but its diagnostic reliability and the relative contribution of nutritional versus surgical risk factors remain uncertain. A prospective observational study was conducted on 30 patients undergoing total laryngectomy with or without partial pharyngectomy between August 2021 and July 2023 at a tertiary referral center. VFSS with Gastrografin was performed on postoperative day (POD) 7 and repeated on POD 14 or 21 if indicated. Diagnostic accuracy of VFSS was calculated against clinically evident PCF. Potential risk factors were analysed using logistic regression. Six patients (20

Cochlear implantation (CI) is a well-established, highly effective, and safe procedure for individuals with severe-to-profound hearing loss. Nevertheless, as with any surgical intervention, particularly implant surgery, post-operative challenges may arise due to various factors. This study presents a surgical audit of revision surgeries performed at an Armed Forces CI center. A retrospective analysis was conducted on CI cases performed at the Armed Forces CI center over a 7-year period (October 2016 to September 2023). Data were reviewed to assess intra-operative and post-operative complications, as well as the incidence and causes of unplanned revision surgeries. Out of total 315 CI, 19 (6.03

Delineating boundaries for salvage brachytherapy in recurrent/second primary head and neck squamous cell carcinoma after radiotherapy is frequently compromised under standard white light. This pilot study evaluates the feasibility, technical success and safety of intraoperative NBI to guide catheter and surface mould application. This prospective feasibility case series evaluated four patients presenting with localized, small-volume HNSCC within high-dose overlapping fields. Three patients underwent NBI-guided interstitial High-Dose-Rate (HDR) brachytherapy; one received an NBI-guided custom surface mould. Real-time target encapsulation, toxicity tracking via CTCAE v5.0, response metrics via RECIST v1.1, and 1-year surveillance were implemented. Technical feasibility was 100

Head and Neck squamous cell carcinoma (HNSCC) is one of the most common cancer in developing countries. Most of the patients present with advanced disease and requires rigorous treatment. Routine follow up of the patient is required to detect any recurrence which will substantially affect overall survival of the patient. Narrow Band Imaging is one of the advanced endoscopic modalities which can be used for assessment of the patients during follow-up along with White light examination (WLE) and WB PETCT. An observational study to determine the efficacy and diagnostic accuracy of NBI in early detection of recurrence in follow-up patients with HNSCC was conducted comparing it with WLE, WB-PETCT and HPE. 60 patients who received definitive radiotherapy /Chemoradiotherapy (RT/CRT) for HNSCC were followed up for a period of 12 months with WLE, NBI, WB PETCT and was compared with HPE. NBI demonstrated higher sensitivity (95.45%) and specificity (97.37%) compared to WLE, which had sensitivity and specificity of 77.27% and 92.11%, respectively. NBI also had superior diagnostic accuracy (96.67%) versus white light (86.67%).WB-PETCT had sensitivity of 95.45% and specificity of 92.11% with a diagnostic accuracy of 93.33% for detecting local recurrences. NBI is a more sensitive and accurate tool for detecting early recurrences in HNSCC post RT/CRT, improving patient outcomes through timely intervention. Proper training and standardized interpretation protocols are essential for maximizing its clinical utility.

The conventional approach for insertion of a cochlear implant (CI) electrode is through the cochlea’s scala tympani via round window (RW) or cochleostomy. The surgeon’s preferred route has evolved and varied since the advent of CI. The purpose of this retrospective observational study is to explore reasons for cochleostomy and trends in cochleostomy utilization for CI electrode placement at our center. Observation retrospective data of CI electrode insertion techniques was collected at tertiary care centre over last 22 years (January 2001 to December 2022). Data was analysed with regards to epidemiology, radiological findings and indications of cochleostomy. Total of 670 patients underwent cochlear implantation (CI) during the study period. It was observed that the percentage of patients undergoing CI via cochleostomy route has gradually reduced over the years. The various indications for cochleostomy includes absent or difficult to visualize round window niche, cochlear ossifications, cochlear malformations, electrode design, research purpose and last but not the least surgeons preference in our study. The use of cochleostomy as a route of electrode insertion has decreased significantly at our center as more surgeons have started to prefer the RW approach (RWA). However, there is still a limited subset of patients for whom insertion via RW membrane (RWM) is unfeasible or challenging, and cochleostomy is preferable. As a result, a CI surgeon must be well-versed in both approaches.

Local flaps used in head neck oncological reconstruction are often debated for their oncological safety owing to their blood supply from the draining lymph nodal basin. Melolabial flap (islanded pedicled nasolabial flap/ ipNLF) is one such flap which has gained popularity in the recent past due to its distinct advantages. The oncological safety of this flap has not been studied so far so our objective is to analyse and establish its oncological safety. All patients whose surgical defects were reconstructed using melolabial flap between May 2018 and May 2022 were reviewed retrospectively. Demographic data, tumor features and pathological findings were obtained. The analysis was carried out based on clinical and pathological staging, nodal status and oncological outcome (recurrence at level IB on the side of melolabial flap harvest and recurrence along the pedicle of the flap). Out of 51 patients who had melolabial flap reconstruction, none of them had local recurrence associated with melolabial flap transposition (recurrence at level IB on the side of melolabial flap harvest and recurrence along the pedicle of the flap) However, 10 (19.60

Cochlear implantation has revolutionized the management of congenital hearing impairment, offering remarkable improvements in speech perception and language development for individuals with severe to profound sensorineural hearing loss. However, the optimal timing and approach for bilateral cochlear implantation remains a subject of debate. Prospective observational study, conducted at a tertiary care hospital in New Delhi from July 2022 to Dec 2023 on 30 patients. It is a comparative analysis of two cochlear implantation strategies in Indian children with congenital hearing loss: bilateral sequential and bilateral simultaneous implants and examines speech perception, language development, auditory skills, and quality of life to guide clinical decisions and improve patient outcomes. In the present study, comparison of CAP and SIR scores revealed a statistical difference favouring simultaneous implants at 3 and 6 months, however the favour direction changed towards sequential implants at 9 and 12 months post implantation. Parental satisfaction measured by MAIS and MUSS scale showed better results with sequential implants at all intervals. Decision to implant a patient simultaneously or sequentially, is the one that requires multi-factorial data to be accumulated and tailored as per the individual as the decision taken will affect the overall development of the individual’s physical, cognitive, language and social-emotional future.

Choanal atresia or stenosis (CA/S), whether congenital or acquired, is a rare but clinically significant condition characterized by the obstruction of the posterior nasal aperture. While congenital bilateral choanal atresia (CA) poses an immediate life-threatening risk in neonates due to obligate nasal breathing, unilateral CA may go unnoticed for several years. Acquired forms—particularly post-radiation—are increasingly recognized for their morbidity and impact on quality of life. We present five cases of CA having varied presentation from congenital non syndromic unilateral/bilateral CA to syndromic bilateral CA along with acquired cases of CA post radiotherapy for head and neck malignancies. This case series combines our experience with both congenital and acquired types of choanal atresia, offering a unique comparative perspective on their presentation, diagnosis, and surgical management.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a persistent inflammatory condition of the sinonasal mucosa, often associated with eosinophilic infiltration and significant symptom burden. Oral corticosteroids (OCS) are widely used for short-term disease control, yet treatment response varies significantly across patients. This study aimed to evaluate the clinical, endoscopic, and histopathological response to short-course OCS in Indian patients with CRSwNP and identify predictors of treatment outcome. A prospective observational study was conducted at a tertiary care center in North India over 24 months. Fifty adult patients with bilateral CRSwNP were treated with oral prednisolone (60 mg/day for 7 days, tapered over the next 7 days), alongside intranasal corticosteroids. Clinical response was assessed using the SNOT-22 questionnaire and Lund-Kennedy endoscopic scores at baseline, Day 21, and 3 months. Histological analysis of nasal biopsy specimens evaluated tissue eosinophils, neutrophils, and stromal fibrosis on day1 day 21. Logistic regression was used to identify predictors of steroid response. Sixty-eight percent of patients showed significant improvement in SNOT-22 and endoscopic scores post-treatment. Serum IgE levels reduced significantly (p = 0.001), while absolute eosinophil count showed a declining trend. Histopathology revealed a marked reduction in tissue eosinophilia (p = 0.001). Post-treatment eosinophil count ≤ 10/HPF was strongly associated with treatment response (OR 5.82, p = 0.006). At 3 months, 41.2

Aims: This study aims to assess the post operative outcome of septoplasty based on established subjective score (Visual analogue score (VAS) and objective score (Acoustic rhinometry parameters). It also correlates the relationship between the two scoring system. Materials and Methods: A prospective intervention observational study was carried out from July 2022 to December 2023 at a tertiary care ENT center. It included 50 cases of deviated nasal septum undergoing septoplasty. Diagnosis was made using detailed history and diagnostic nasal endoscopy by a qualified ENT surgeon. Each patient was evaluated by Visual Analogue Scale (VAS) for obtaining subjective parameters and acoustic rhinometry for objective nasal parameters (minimal cross-sectional area at first 2 cm [MCA1] in cm2, minimal cross sectional area at 2–5 cm (MCA2) in cm2, nasal cavity volume at first 2 cm [VOL 1] in cm3, nasal cavity volume at 2–5 cm [VOL 2] in cm3), preoperatively and at interval of 1 week, 1 month, and 3-month postoperatively. Results: Post septoplasty, no significant changes in VAS scores or acoustic rhinometry parameters were observed at 1 week. Significant improvements in VAS scores were noted at 1 and 3 months. MCA1 and MCA2 significantly improved at these intervals, with a negative correlation between VAS and MCA, but no significant changes in volume measurements. Conclusion: We observed a trend in change in minimal cross sectional area values at 1 and 3 months postoperative with no significant corresponding changes in nasal volume. This change correlated with established subjective parameter VAS score and validates AR as a reliable assessment tool. . It emphasizes the functional nature of the Septoplasty surgery with preservation of nasal anatomy. We also recommend that AR can be used to assess and track the outcome of septoplasty.

Unilateral vocal cord palsy (UVCP) is a condition that significantly impacts voice quality and swallowing function, leading to considerable challenges in communication and nutrition. Percutaneous Injection Medialisation laryngoplasty (PIML) has emerged as a pivotal intervention to restore vocal cord function in affected patients. To evaluate the vocal and swallowing outcomes in cases of unilateral vocal cord palsy by PIML based on vocal and swallowing parameters. A cross-sectional analytical study was conducted at tertiary care hospital among 40 adult patients of UVCP without structural lesion of larynx and were treated with PIML using hyaluronic acid. Vocal and swallowing parameters were measured prior to procedure and post procedure at 2 h, 3 month and 6 month. Subjective parameter like VHI-30 and objective parameters were measured by using (1) Acoustic analysis (2) Perceptual Evaluation by GRBAS, (3) Aerodynamic analysis by Mean phonation time (MPT). Swallowing outcome measured by using Penetration-Aspiration scale (PAS) on Functional Endoscopic Evaluation of Swallowing (FEES). 40 patients with UVCP treated with injection laryngoplasty under LA. There was significant decrease in VHI (by 32.05 points, p < 0.05), GRBAS (by 5.35 points, p 0.05), Jitter (by 0.63 points, p < 0.05), Shimmer (by 2.34 points, p < 0.05) and Penetration aspiration score (by 1.8 points, p < 0.05) noted 2 h post procedure and this effect maintained till 6 month of follow up. There was significant increase in MPT (by 7.2 seconds, p < 0.05) and HN Ratio (by 6.22 points, p < 0.05) noted 2 h post procedure and this effect maintained till 6 month of follow up. All patients (100

Spontaneous cerebrospinal fluid (CSF) rhinorrhoea, often linked to benign intracranial hypertension (BIH), arises from skull base defects and carries a risk of serious complications such as meningitis. While acetazolamide can temporarily reduce intracranial pressure, recurrence remains problematic. This prospective study aims to assess the relationships between body mass index (BMI), defect size, disc edema severity, and recurrence duration, and to compare outcomes of conservative versus surgical management. A prospective observational study was conducted on 30 adults with spontaneous CSF rhinorrhoea from November 2021 to October 2023. Initial treatment involved oral acetazolamide (250 mg thrice daily); patients with recurrence underwent endoscopic endonasal repair. All surgical patients received two doses of the pneumococcal vaccine, 8 weeks apart. Associations between BMI, defect size, disc edema, and recurrence duration were analysed using Pearson’s correlation coefficient. Mean BMI was 26.63, and mean defect size was 7.37 mm. Moderate positive correlations were observed between BMI and recurrence duration (r = 0.45, p = 0.018), and between disc edema and recurrence duration (r = 0.52, p = 0.004). A weak yet significant correlation was found between defect size and recurrence duration (r = 0.38, p = 0.032). Conservative management failed in all cases; recurrence occurred in 100

Granulomatous diseases of the nose and paranasal sinuses (PNS) are rare but present significant diagnostic challenges due to their overlapping features with common sinonasal conditions. Early diagnosis is critical to prevent serious complications, yet clinical and radiological findings often mimic infections, inflammatory diseases, or malignancies. This case series describes four patients with granulomatous diseases of the PNS, including granulomatous invasive fungal rhinosinusitis, granulomatosis with polyangiitis (GPA), and IgG4-related disease. Clinical presentations, diagnostic challenges, treatment strategies, and outcomes were analysed to highlight key learning points. All patients demonstrated complex clinical courses, with initial misdiagnosis in two cases due to misleading serological results. Careful histopathological review, repeat biopsies, and multidisciplinary collaboration were essential in establishing the correct diagnosis. Targeted medical management based on final diagnoses led to favourable outcomes, with no relapses observed during follow-up. Granulomatous diseases of the PNS require a high degree of clinical suspicion, timely tissue diagnosis, and close interdisciplinary coordination. Reliance on serology alone may lead to errors; histopathology remains the cornerstone of diagnosis. Structured diagnostic approaches and vigilant follow-up are critical to improving patient outcomes in these complex cases.

Background Early-stage glottic carcinomas can be treated with either laser surgery or radiotherapy. Both approaches have demonstrated similar cure rates. However, the question of which modality is superior in terms of voice outcomes remains a topic of debate. Methods In our study, we conducted a comparison of short-term phonatory outcomes in patients with primary early glottic cancer who underwent treatment using both modalities. We assessed these outcomes using videostroboscopy and voice analysis software at three time points: immediately following treatment, at 1 month, and at 3 months post-treatment. Results Voice analysis revealed that laser surgery had a more favorable immediate effect compared to radiotherapy in parameters such as jitter, shimmer, harmonics-to-noise ratio, and fundamental frequency. However, at the 3-month post-treatment mark, both treatment modalities demonstrated similar effects. Additionally, both modalities had comparable effects on maximum phonation time. Videostroboscopy observations showed that mucosal wave forms were more prominent immediately after laser surgery and gradually improved following radiotherapy. Furthermore, patients with incomplete glottic closure experienced recovery after both treatment modalities. Conclusion Based on the results, there are better outcomes immediately following LS compared to RT. However, after a 3-month period, the outcomes of both treatment modalities become comparable. The treating physicians must consider various factors such as complications, patient-specific considerations, treatment costs, and duration to make informed decisions. A personalized approach considering the individual patient’s circumstances is crucial in achieving optimal results in the management of T1 laryngeal cancer.

Background Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed.Methods A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed.Results A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging.Conclusions STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications.

Transoral Parapharyngeal Space Surgery (TOPPSS) is often opted by surgeons for parapharyngeal tumors. But its broad implementation is curtailed by limited exposure and the potential for various complications to arise. In this article, authors have outlined the ‘DK et al. TOPPSS Criteria’ encompassing several clinic-radio-pathological elements for consideration, while opting the transoral approach based on literature and references therein. ‘DK et al. TOPPSS Criteria’ encompasses factors including nature, site and extent of tumour, capsule, involvement of neurovascular structures, cytopathology, vascularity, and mouth opening. Thirteen patients diagnosed with parapharyngeal tumors were selected as per the proposed criteria and were subsequently subjected to TOPPSS. Additionally, an endoscope was incorporated to enhance visualization. All patients exhibited favourable outcomes in terms of complete excision, operation time, blood loss, complications, hospital stay, wound healing, and follow-up. TOPPSS is an invaluable and evolving technique which yields favourable outcomes when carefully applied. Comprehensive preoperative evaluation and proper patient selection using the ‘TOPPSS Criteria’ remain essential to the success of this approach. The use of endoscopic assistance further enhances its capabilities, allowing for effective resection with preservation of critical neurovascular structures. Authors have also proposed the DK et al. Anterior Tonsillar Myo-mucosal (ATM) flap, that can be easily elevated, conserved, and repositioned; serving to enhance primary wound healing, enable early oral intake and prevent the exposure of neurovascular structures within the tumor bed.

Background:This study aims to compare the efficacy of narrow band imaging (NBI) endoscopy and contact endoscopy in early diagnosis of squamous malignancies of upper aerodigestive tract.Methods:This study was of 18 months duration, sample size 50, and carried out at tertiary care hospital. The patients were subjected initially to NBI endoscopy followed by contact endoscopy. Thereafter, the lesion was biopsied and subjected to histopathological examination as is done routinely. The images obtained were analyzed based on criteria proposed by earlier studies and compared with histopathological examination as gold standard.Results:The sensitivity, specificity, and negative predictive values of NBI in early diagnosis of squamous malignancies of upper aerodigestive tract were high and better than contact endoscopy.Conclusion:Endoscopic NBI is a noninvasive and promising tool used for in vivo differentiation between malignant and nonmalignant lesions of upper aerodigestive tract by using morphology of mucosal capillaries and is more efficacious than contact endoscopy. It can be employed as part of routine ENT examination in outpatient departments; however, it has got a learning curve associated with it.

The aim of the study was to determine the post surgical outcomes in pediatric adenotonsillar hypertrophy with OSA using portable polysomnography (PSG), OSA 18 Questionnaire and Quality of life (QoL) scores. Secondly to correlate the subjective outcomes with objective scores of polysomonography. A prospective, single-arm, nonrandomized, single center study was performed at a tertiary care centre on children aged 3–12 years (n = 30) with adenoid hypertrophy/ tonsillar hypertrophy/adenotonsillar hypertrophy and symptoms suggestive of OSA. All subjects underwent appropriate surgical intervention. A portable PSG and OSA 18 questionnaire evaluation was performed pre surgery and 06 weeks post surgery to assess objective and clinical assessment for OSA. The mean age of children enrolled in the study was 8.68 ± 3 years. The mean pre treatment AHI was 12.56 ± 13.16 which improved to 1.72 ± 1.53 post surgery and was statistically significant ( p < 0.05, Wilcoxon signed rank test). There was a statistically significant improvement in other PSG indices such as RDI and ODI post surgery also. The mean total symptom score (TSS) and QoL score also showed a statistically significant improvement post treatment ( p < 0.05). However there was no correlation between the PSG and OSA 18 questionnaire scores pre and post surgery. Children with OSA like symptoms can undergo a portable polysomnography pre and post surgery to demonstrate severity of OSA and objectively monitor improvement in OSA post treatment. In the absence of availability of PSG, OSA 18 questionnaire is a suitable alternative to monitor disease severity and outcomes. Further studies may plan to include impact of paediatric OSA on other function such as the cardiac, dentition & malocclusion and neurocognitive function.