Lymphangiomas are congenital benign lesions commonly seen in pediatric age group with a rare occurrence in the region of head and neck, commonly presenting as asymptomatic masses. Cervical lymphangioma is a rare entity among adults, and giant sized lymphangiomas in this region have sparse mention in literature. This case report describes the rare presentation of a giant cervical lymphangioma and the challenges involved to treat such masses in the region of head and neck. We encountered a rare case of a 52 year old female who presented with a 10 × 5 cm swelling in the right posterior triangle of neck swelling since 6 months extending from skull base up till clavicle. Pathological and radiological entities confirmed the lesion as a “giant cervical lymphangioma”. Head and neck lymphangiomas are congenital lesions of benign origin. Lymphangiomas have been classified as macrocystic if larger than 2 cm, and microcystic if less than 2 cm. Our description of a macrocystic 10 × 6 cm lesion is hence definitely one of the largest cervical lymphangiomas encountered till date. It’s a problematic and arduous plan of treatment for such masses in head and neck with a high chance of recurrence if incompletely removed.

Ewing’s sarcoma is a malignant small round cell tumor that belongs to the primitive class of neuroectodermal tumors. Ewing’s sarcoma generally arises in the long bones of the extremities, and sinonasal localization of Ewing’s sarcoma in pediatric population is an extremely rare event. The combination of histopathological examination and ancillary methods is extremely important to establish the diagnosis of Ewing’s sarcoma. The treatment for Ewing’s sarcoma includes a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. Through this report, we try to communicate our experience and highlight the challenges encountered in diagnosing and approaching two extremely rare cases of pediatric sinonasal Ewing’s sarcoma.

Objective:To assess the utility of an intraoperative scoring system for mucormycosis and to predict prognosis by comparing the score with postoperative outcomes. Methods:This study was conducted among 80 patients with mucormycosis who underwent surgical management with mandatory pterygopalatine fossa and infratemporal fossa exploration. All cases were scored using our intraoperative scoring assessment tool. Postoperative outcomes in terms of favourable prognosis and mortality were evaluated and compared with demographics, clinical history and intraoperative findings. Results:An intraoperative score of more than 25 was statistically significant in predicting mortality (p < 0.0001). In all, 86.7% of patients with a score above 25 succumbed to the disease. Statistical significance of mortality (p < 0.05) was observed in those with involvement of pterygopalatine fossa (78.9%), orbit (73.7%), infratemporal fossa (57.9%), cribriform plate (36.8%) and those with history of intake of antiviral drugs (47.4%), use of supplemental oxygen (31.6%) and renal failure (26.3%). Conclusions:This study enabled better prediction of postoperative prognosis in mucormycosis and reiterated the importance of exploration of pterygopalatine fossa and infratemporal fossa in management and prognostication of invasive fungal sinusitis.

Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues.

A man in his 50s presented with a 2-month history of left ear discharge associated with hearing loss and weakness of left half of face since 15 days. The patient had no comorbidities, but he gave history of being treated for COVID-19 pneumonia 2 months ago post which he started experiencing left-sided aural symptoms. Clinical examination of ear revealed a subtotal perforation with multiple granulations in middle ear. Facial nerve examination revealed grade 3 lower motor neuron palsy. The biopsy of the granulations was sent to aid in diagnosis which later confirmed left ear mucormycosis. Otological involvement with facial palsy and sudden sensorineural loss in a patient with prior history of COVID-19 has not been reported until in literature. We try to communicate our experience to bridge the gap in understanding and managing this extremely rare occurrence of mucormycosis in the ear of a patient diagnosed with COVID-19 infection.

Background: Chronic otitis media (COM) is a pathology involving the middle ear cleft characterized by discharging ear and a non-healing perforation in tympanic membrane. Different techniques have been used for closing the perforation but interlay myringoplasty has become popular among surgeons since the past few decades. Objectives: To evaluate and compare the success rate of Type-1 interlay tympanoplasty in large tympanic membrane perforation with or without cortical mastoidectomy in terms of graft take-up rate and improvement in hearing outcomes. Materials and methods: A retrospective study for the period of eighteen months with total of 90 patients further subdivided into two groups. Group I of 45 patients underwent Type-1 interlay tympanoplasty alone, and 45 patients in Group II underwent type-1 interlay tympanoplasty with cortical mastoidectomy. Results: In group I the mean pre-operative, post-operative pure tone average and air bone gap was found to be 36.49 ± 4.49, 29.24 ± 4.39 and 25.11 ± 3.15, 14.76 ± 3.12 respectively. In group II the mean pre-operative, post-operative pure tone average and air bone gap was found to be 35.60 ± 5.27, 25.96 ± 5.29 and 23.96 ± 3.76 and 13.33 ± 3.38. An independent sample t-test was performed for intergroup comparison and found to be statistically significant (p < 0.005). The graft uptake was 95.5

Lateral neck masses are common in children, ranging from simple benign diseases to pathologies with malignant potential. Plexiform neurofibromas are extremely rare peripheral nerve sheath tumours involving multiple nerve sheath fascicles. They are typically seen in the paediatric population, with the majority affecting the craniofacial area and neck. Due to the close clinical and histological resemblance with other benign neck lesions such as lymphadenitis and branchial cysts, these cases can often go misdiagnosed. We describe a lesion in a young girl who presented with a progressive lateral neck swelling and how it was managed.

PURPOSE:To determine whether preeclampsia and gestational diabetes mellitus is a risk factor for cochlear damage and sensorineural hearing impairment in infants.MATERIALS AND METHODS:Longitudinal study was conducted in 2 tertiary referral centers. 1068 neonates were included, who were born to preeclampsia, gestational diabetes mellitus, and healthy mothers. The hearing evaluation was done using DPOAE on day 2 and for those who failed the initial DPOAE on day 2, underwent repeat DPOAE on day 15, ABR was done on day 30 if repeat DPOAE was Refer. The results were compared between the groups and analyzed.RESULTS:On initial DPOAE, bilateral ear absent DPOAE rates were 19.5%, 15.8%, and 3.5% among preeclampsia, Gestational Diabetes Mellitus (GDM), control groups respectively. The difference was statistically significant (P < .001). Also it was noted that absent DPOAE was significantly high at low and mid frequencies (1000, 2000, 3000, and 4000 Hz) in bilateral ear. However the difference in repeat DPOAE among the groups were not significant (Right ear P = .17, Left ear P = .31). Infants who failed repeat DPOAE test underwent ABR test in which 3 of GDM group, 2 infants of preeclampsia group and 1 infant of control group had absent ABR test.CONCLUSION:This study reveals that GDM and preeclampsia showed remarkable association of hearing loss at lower and mid frequencies which was transient. The prevalence of absent DPOAE was corresponding to the severity of the maternal conditions under the study.

To introduce an intraoperative scoring system for covid-19 associatedmucormycosis An observational study conducted among 43 cases of confirmed CAM whichincluded 35 males and 8 females, with an average age of 56 years. The surgicalapproach adopted in our cases included endoscopic surgical debridement withDenker's approach including mandatory pterygopalatine and infratemporal fossaexploration. All cases were intraoperatively scored using our designed intraoperativescoring assessment tool for mucormycosis. Postoperatively patient recovery wasassessed using C reactive protein levels and weekly imaging. Although an early observation in the post op period we observed highermortality among cases reporting with high scores as per our intraoperative reportingsystem. At the end of 2 months of completed treatment we report 6 cases of mortalityamong whom 5 cases were found to have scores (> 25) and one reported with a scoreof 18. This assessment helped us in grading the disease severity and also gaveus an insight about the postoperative prognosis too. Global scientific collaboration andreporting of a validated tool for CAM is of paramount importance to increase theknowledge with regard to this emerging disease.

The main aim of the study was to assess various ENT symptoms in COVID 19 patients, also to investigate the severity of ENT symptoms among COVID 19 patients and find their relation on basis of scores among five discrete domains of SNOT 22 (Sino nasal Outcome Test). A prospective observational study was conducted among 135 patients between 18 to 75 years of age, in the month of September 2020 with COVID-19 infection having mild, moderate disease who were admitted to our hospital. Subjects were divided into groups according to their presenting ENT symptoms based on age, gender and other comorbidities and differences between the groups were examined. The sinonasal symptoms were assessed using the SNOT 22 questionnaire. A strong statistical significance with loss of smell and taste sensation was noted in patients above the age of 40 years. It was also noted that the patients who presented with cough above the age of 40 years were significantly more. Evaluation of sinonasal symptoms using SNOT 22 questionnaire showed that Extranasal rhinologic symptoms, Psychological dysfunction, Sleep dysfunction had significantly higher association among patients who were more than 40 years. We observed that, Extranasal rhinologic symptoms were significantly higher among males than females. There is thus an emergent need to develop a uniform tool to assess the various ENT symptoms. In our study we assessed the patients with COVID 19 using a standard questionnaire to observe the symptomatology, psychological and sleep dysfunctions due to sinonasal issues, and to closely understand the relationship of various symptoms in a meticulous manner.

Trichilemmal carcinoma is a rare malignancy of hair follicles affecting sun-exposed and hair-bearing skin; occurrence over pinna is unusual. This case report describes one such uncommon presentation in a 71-year-old man who came with a pinna swelling clinically mimicking basal cell carcinoma. Diagnosis is an arduous task due to its close resemblance with more common cutaneous tumors. Misdiagnosis or delay in intervention may lead to recurrence and local metastasis.

A recurrent mass in the nose can pose diagnostic and therapeutic challenges. Even more so, if it exhibits rapid growth, displays unusual clinical features, is a rare histopathological diagnosis or if the patient is unavailable for regular follow-up. We present a case of a middle-aged retrovirus-positive man who underwent surgical removal of a recurrent nasal mass. Histopathology revealed a diagnosis of low-grade fibromyxoid sarcoma, a rare entity in the sinonasal tract. Immunohistochemistry plays a crucial role in clinching the diagnosis, especially for lesions with fibrous and myxoid components. Early and complete surgical resection diminishes the likelihood of recurrence and metastasis.

Introduction: Adenoidectomy is one of the most commonly performed operation worldwide.Most widely used approach for surgery is conventional curettage method.However, as this method is associated with high incidence of residual adenoid tissue at the end of surgery which results in recurrence of disease, a newer endoscopic microdebrider assisted approach is becoming popular these days.Though various studies have shown its efficacy in more complete removal of adenoids, its functional outcome on middle ear function remains to be explored.Objectives: To compare pre and post operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic micodebrider assisted adenoidectomy.Materials and Methods: Patients were diagnosed cases of chronic adenoiditis which were divided in groups of 25 each.Patients in first group underwent conventional curettage adenoidectomy while in second group patient underwent endoscopic microdebrider assisted adenoidectomy.Pre and postoperative pure tone and impedance audiometry were performed for all the patients and the outcomes were compared.Results: Endoscopic microdebrider assisted method resulted in better outcomes which were statistically significant as compared to the conventional curettage.Criteria such as hearing threshold (p value 0.004 at second follow up), peak pressure (p value 0.045 at first follow up), tympanogram (p value 0.016) showed that endoscopic method was better while peak compliance (P value 0.340 at first follow up) didn't show any significant difference between the groups.Conclusion: Endoscopic microdebrider assisted method of adenoidectomy has a definite advantage of better visualization and results in more complete removal of tissue and hence results in better improvement in middle ear functions as compared to the conventional curettage.