Head and neck squamous cell carcinoma (HNSCC) accounts for sixth most common cancer worldwide. Only one third of HNSCC patients are diagnosed at an early stage. Failure in early diagnosis is one of the reasons for low survival rates in HNSCC which is mainly attributed to lack of diagnostic biomarkers The significance of p16 as a biomarker in cases of HNSCC is a subject of on-going debate and its prognostic role in HNSCC is less clear. A Prospective Cross-Sectional Study conducted in the Department of Otorhinolaryngology, Head and Neck Surgery, in collaboration with Department of Pathology, in a tertiary care hospital and teaching medical college for period of 18 months. Of the 50 positive subjects with HNSCC, 9 patients were found to be positive for p16. Majority of the participants in our study had addiction history (94

Introduction: The world has been affected by COVID-19 in recent years. There are various sampling sites which have given different yields. Methods: In cross sectional, prospective and descriptive study, 3 sampling sites namely oropharyngeal (OP), nasopharyngeal (NP) and oral saliva (OS) were compared as regards to COVID-19 yield. Results: A total of 939 samples were collected from 313 patients. Among these patients, 16 had samples positive from all three sites. There were 6 patients who had both nasopharyngeal and oropharyngeal swabs which showed positive results for COVID-19, while there were 4 patients each in whom only either oropharyngeal or nasopharyngeal swabs were positive. One patient had positive sample for oropharyngeal and oral saliva, while there was no patient in whom only saliva was positive. Thus a total of 27 patients had atleast one sample which was positive. Conclusion: Both nasopharyngeal and oropharyngeal samples are important and also both samples should be taken from all patients in order to reduce false negative results. Oral saliva as the only sampling site cannot be relied on owing to its low yields.

Introduction: Thyroid surgeries are routinely performed in day-to-day practice.However, parathyroid surgery is a rarely performed surgery that calls upon the highest level of skill and knowledge on the part of the surgeon to perform a complication-free surgery.Parathyroid adenomas are the most common tumors of parathyroid glands leading to hyperparathyroidism.Most of these patients are primarily seen by orthopedic surgeons or physicians and are then referred to the ENT Department for surgery.Aim and objective: To present the clinic-radiological -pathological profile of parathyroid adenoma patients.Materials and methods: Study design: Prospective observation study.Setting: Tertiary Care Centre and

Background Olfactory and taste dysfunctions have been identified as prominent signs of COVID-19 infection. The data on its prevalence, time of onset, and recovery is highly variable. Objective The study was aimed at establishing the incidence of and the factors influencing smell and taste disorders in COVID-19-affected patients. Methodology Telephonic interviews were used to collect data on the symptoms of COVID-19-positive patients, with an emphasis on smell and taste disorders. Patients have severe disease and a history of illnesses that may affect olfaction or taste, and those unwilling to participate were excluded. Results A total of 1488 COVID-19-positive patients were identified. A total of 772 were included and interviewed, and their data were analysed. A total of 242 (31.3%) patients developed symptoms related to smell and/or taste. Anosmia (149) and ageusia (152) were the most common. Younger patients were more commonly affected ( p = 0.0016). The presence and degree of smell symptoms and taste symptoms showed a small positive correlation ( r = .234, p < .001). A strong relationship was seen with fever ( r = .825, p < .001) and a significantly moderate relationship with breathing difficulty. There was no significant difference based on age or sex for the recovery of smell or taste sensations. There was a significant correlation between taste recovery and smell recovery times ( p < 0.00001). Conclusion Smell and taste disorders, as early clinical symptoms of COVID-19, may have a diagnostic as well as a prognostic value. Treatment protocols for these patients are yet to be defined. A positive association between these symptoms and breathing difficulty was found, and we recommend COVID-19 testing and monitoring of symptoms for all patients with new-onset OTD symptoms. A combination of active enquiry about these symptoms, along with objective testing when the patients present with COVID-19 symptoms may help in better understanding of the pathophysiology and timely initiation of treatment.

Abstract Background: To report a case of phosphaturic mesenchymal tumour of nose highlighting the diagnostic challenges involved. Case presentation: A 50 years old male who had history of multiple lower limb fractures presented with epistaxis and a vascular mass in left nasal cavity that enhanced on contrast-enhanced computed tomography (CECT), and MRI. The patient had raised serum phosphate and PTH levels. The tumour was excised endoscopically and the patient recovered completely. Conclusion:Malignant Phosphaturic mesenchymal tumors (PMTs), although rare, may behave aggressively, recur and metastasize. They are difficult to diagnose and should be kept in differential diagnosis of nasal tumours who present with osteomalacia.

Purpose: The current study explored the bacteriological profile in the tonsillar core in patients undergoing ton-sillectomy and compared it with tonsillar surface organisms. The antibiotic sensitivity and resistance patterns were also studied.Materials and methods: This prospective and observational study was conducted in the Department of Otorhino-laryngology, Head and Neck surgery in a tertiary care institute, on a total of sixty-one patients clinically diagnosed as chronic tonsillitis and undergoing tonsillectomy. Tonsillar surface culture swabs and core tissue specimen were sent in separate vials. The culture isolates and their antibiotic sensitivity were analysed and compared.Results: Bacterial growth was detected in 61% of the cases, in cultures from the surface or the core tissue or both. 50.8% specimens of core tissue versus 31.1% of tonsillar surface samples revealed bacterial growth. Of the 13 cases in which surface and core both had bacterial culture growth, the same pathogens were identified in 8 cases. Pseudomonas aeruginosa was the most commonly reported organism in both tonsillar core as well as surface swab cultures. Conclusion: Our study shows that surface swab culture is not always a reliable indicator of organisms present in core of tonsils in cases of chronic infection. The surface swabs did not always match the pathogens in the core. The higher prevalence and the variability of pathogenic organisms in the core tissue as compared to the surface suggests that a targeted antibiotic treatment based on surface culture swabs is unlikely to eradicate them.

Background: Due to the inappropriate use of antibiotics along with poor compliance of the patients, resistance patterns have developed to commonly prescribed antibiotics for ear infections, especially in children. Otitis media, a common ear infection is one of the key contributors to antibiotic resistance. It is estimated that up to 40% of all preventable hearing impairments are caused by ear infections, leading to frequent antibiotic usage, especially in developing countries. Considering the upsurge in drug resistance, a study was conducted to provide an update on current bacteriological prole and antimicrobial susceptibility pattern as it would be useful for clinicians to start with the appropriate antibiotics at the earliest and to reduce the burden of emerging drug resistance especially during the ongoing Covid-19 pandemic. Material method: A retrospective study over a period of three years, starting from January 2018 to December 2020 in a tertiary care hospital where all ear discharge/ pus samples were processed. A total of 1050 ear discharge samples were cultured according to the standard microbiological procedures. Isolates were identied by conventional methods and antibiotic susceptibility proles were determined by standard disk diffusion method. All this data was then evaluated retrospectively. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically signicant for the same. Results: Staphylococcus aureus and Pseudomonas aeruginosa were the most common microbes to be isolated. Gram positive cocci had high sensitivity to doxycycline and linezolid while Gram negative bacilli were sensitive to amikacin, imipenem, and piperacillin and tazobactam among the wide spectrum of antibiotics which were tested. These results indicate a rise in drug resistance in both Gram positive and Gram-negative microorganisms to many commonly prescribed antimicrobial agents by means of multiple drug resistance mechanisms. Conclusion: Patterns of sensitivity and resistance, help in proper selection of empiric therapy and prevention of emergence of resistant strains. Both culture and susceptibility tests have paramount importance for better management of ear infections, especially the drug-resistant ones.

Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Aspergillus is a ubiquitous fungus in the Indian environment. Spores are constantly circulating in hospital and community environments alike. Infections like COVID-19 which affect not only innate immune system but also lead to local immune-compromization especially in the respiratory system make the patient vulnerable to infections like Aspergillosis. Hereby, we present the prevalence of Aspergillus infection in a tertiary care center over a period of 1 year with special reference to co-infections with COVID-19 as Aspergillosis or mixed infection (Aspergillosis and Mucormycosis). Material and Methods All the samples which were submitted to Mycology laboratory during the time period of 1 year from January 2021 to December 2021 were included in the study. The samples were processed as per the standard mycological techniques for direct examination and culture. Those patients which had direct KOH mount positive for septate hyphae and grew Aspergillus on culture were included for the purpose of this study. Records of Aspergillosis patients who were positive for COVID-19 too were assessed to look for significant associating factors. Results Out of a total of 6863 samples, 66 samples came out to be positive for Aspergillus sp. Out of which, 55 were identified phenotypically as A. flavus, 3 A. fumigatus, 2 A. terreus and 1 was A. niger. In five of the strains, species could not be identified even phenotypically and were reported as Aspergillus sp. Maximum isolates (43) were from nasal and paranasal sinuses (sinus discharge, nasal tissue, nasal polyp, nasal muck, nasal crust, maxillary meatus etc) 16 were pulmonary samples (sputum, tracheal aspirate, bronchoalveolar lavage, pleural fluid, lung tissue), two were corneal scrapings, two samples were dental tissue and palatal necrosed material and two were nail samples. One sample was from a patient with ear discharge. A total of 15 patients had COVID-19 infection at the time of diagnosis or within 3 months prior. In all, 12 patients had co-infections of Aspergillus and Mucormycetes (9 being COVID positive too), and 2 patients had co-infection of Aspergillus and Candida. Records of COVID-19 patients revealed that all 12 patients with co-infection of Aspergillus and Mucormycetes were treated as per guidelines for Mucormycetes infection. Out of other three, two were confirmed CAPA as per the criteria. One patient was treated for COVID-19 infection only. Conclusion Mucormycosis was another infection during COVID-19 times, which was like a huge wave, sweeping all attention. Rather Aspergillus infections got shadowed by mucormycosis despite the fact that during COVID-19 times, as many as 15% of cases were found to be positive for Aspergillosis in COVID-19 positive patients, especially in ICU areas. In the times to come, it is speculated that sequelae of Aspergillus infections may be seen among COVID-19 patients. Emerging drug resistance among Aspergilli can worsen the situation further.

BACKGROUND:The aggressiveness of paediatric cholesteatoma has long been a matter of debate. While much of the evidence is substantiated by data from the Western world, it is further limited by the retrospective nature of most studies. Therefore, this paper presents a comparative analysis of various characteristics of cholesteatoma between paediatric and adult populations seen at our centre.METHODS:A total of 50 patients (25 adults and 25 paediatric) with clinical diagnosis of chronic suppurative otitis media with cholesteatoma underwent canal wall down mastoidectomy over a period of two years. The intra-operative findings were noted and patients were followed up for six months.RESULTS:There was more extensive spread and ossicular erosion in paediatric cases. However, complications such as facial canal dehiscence and lateral semicircular canal dehiscence were more common in adults.CONCLUSION:Paediatric cholesteatoma is more aggressive and invasive than adult cholesteatoma, and the clinical behaviour is consistent with findings from other parts of the world.

Introduction Congenital midline sinus over tip of nose is a rare clinical presentation. Accurate diagnosis should be done to rule out intracranial extension and to prevent recurrence. Appropriate surgical approach depends upon location, extent and degree of intracranial extension. Management entails complete surgical excision of sinus tract. We discuss a rare case, where external rhinoplasty approach was used for excising recurrent sinus and patient was disease free. Case Report A 29 year old male patient with midline nasal tip sinus presented in our institute with history of opening over tip of nose since childhood associated with recurrent episodes of discharge from opening. Our objective is to present clinic-radiological-pathological profile of congenital nasal sinus along with review of literature. Discussion Nasal dermoid is rare embryological anomaly of ectodermal and mesodermal origin. Radiological imaging should be considered to rule out any intracranial extension. Goal of management is complete surgical excision with meticulous pre-operative and surgical planning to avoid complications and recurrence. External rhinoplasty provides best surgical exposure and allows excision of sinus tract.

Pneumosinus dilatans is an abnormal expansion of the air-filled paranasal sinuses. Usually found incidentally on radiology, it does rarely present in the form of cosmetic, neurological, ocular or rhinological pathologies. We report a case of a young male with complaints of bilateral gradual vision loss, diagnosed as pneumosinus dilatans with optic nerve atrophy. He underwent bilateral optic nerve decompression. A review of all cases of pneumosinus dilatans, reported over the last 100 years in English literature is presented.

Abstract Chondrosarcomas are the second most common primary malignant bone tumors. Head and neck chondrosarcomas constitute less than 10% of these tumors, rarely arising from the nasal septum. These are locally aggressive malignant tumors arising from the cartilaginous framework of the nasal septum. Rarity of the tumor coupled with nonspecific symptoms makes it a diagnostic dilemma. Diagnosis requires endoscopy, radiology, and final histopathology for confirmation. Treatment is mainly surgical, requiring complete surgical excision with clear margins. Radiation has a role in unresectable tumors or for tumors with positive margins after surgery. Survival depends on the grade of tumor that predicts the metastatic potential of the tumor. We present a rare case of chondrosarcoma arising from the nasal septum in a 29-year-old young female presenting with complaints of nasal obstruction. Computed tomography was suggestive of a calcified cartilaginous tumor arising from the nasal septum. Endoscopic excision was done and postoperative histopathology showed grade II chondrosarcoma with clear margins. No adjuvant treatment was given to our patient and 2 years post-excision patient is disease free. To conclude, chondrosarcoma of the nasal septum is a rare tumor, with nonspecific symptoms. Surgery with clear margins remains the treatment of choice. Prognosis depends on the extent of tumor at presentation, resection margins, and grade of tumor.

In the past 10 years, there have been several reported cases of the existence of a vaccine-preventable disease from several Indian states. Diphtheria, re-emerge as a major public health problem as this fatal infection used to be noticed in toddlers and school-going has now been stated to occur amongst adults also despite the fully functional Universal Immunisation Program (UIP) in India. India contributed about 53.9% of diphtheria cases globally in the year 2016. In cases, the reason for the upsurge could be attributed to lack of proper immunisation or waning of vaccine-induced immunity with increasing age. Here, a case of a 24-year-old adult male was reported who presented with acute membranous tonsillitis, a preliminary diagnosis made on physical examination. Corynaebacterium diphtheriae was isolated. Finally, the isolate was confirmed as C. diphtheriae using Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) system.

Introduction A schwannoma is a benign nerve sheath tumuor of myelinated nerves arising from Schwann cells. In the head and neck region, the most common site is the eighth cranial nerve (vestibulocochlear). Only 4% of schwannomas seen in the head and neck region arise from the nose and paranasal sinuses involving branches of the trigeminal nerve (ophthalmic or maxillary) or from the autonomic nervous system. Case Report A 29 year old female patient presented to the Ear, Nose and Throat Out Patient Department with the complaints of left sided nasal obstruction and left sided nasal bleed. On anterior rhinoscopy, a single, smooth, greyish, non-pulsatile polypoidal mass was seen in the left nasal cavity seeming to be arising medial to middle turbinate. A provisional diagnosis of benign nasal mass was made and the patient underwent excision under general anaesthesia. On histopathology, an impression of Schwannoma was made. Discussion Sino-nasal schwannomas are a very rare entity with non specific imaging studies. A confirmatory diagnosis can be made only after histopathology. The treatment modality of choice is surgical excision of the mass, taking care to leave no residual, so as to prevent a recurrence.

Introduction This is a very interesting case of retained homicidal foreign body in the nose in contrast to most of the foreign bodies which are accidental. Case Report A 27 year old male presented to ENT emergency with alleged history of assault over face with sharp object following which patient developed nasal bleed. On examination vertical laceration of approximately 8 cm in length was present along left naso-orbital groove extending superiorly from medial canthus of left eye and inferiorly to nasal alar cartilage. On anterior rhinoscopy a metallic foreign body was seen in both nasal cavities, which appeared to be crossing from left to right side piercing the nasal septum. Foreign body was removed via open approach. Discussion Penetrating maxillofacial injury with foreign body impaction are less common. High index of suspicion is required in diagnosing these cases. Radiological intervention should be done to get idea of exact location and extent of foreign body. Lateral rhinotomy is a useful approach in removing these foreign bodies.

Enlarged adenoids in children can lead to obstruction of the ET, leading to negative intratympanic pressure and development of Otitis media effusion. Adenoid-nasopharyngeal ratio (ANR) on lateral radiograph of nasopharynx, is one of the most reliable and cost-effective ways of determining the size of adenoids with respect to the nasopharyngeal space. Patients who were clinically diagnosed with adenoid hypertrophy, above the age of 5 years, undergoing adenoidectomy were included in the study. Lateral nasopharynx radiograph, Pure tone audiometry (PTA) and tympanometry were performed. The ANR calculated, graded, and compared with the PTA, tympanograms and size on endoscopic assessment. Taking 0.835 as cut-off value, significant correlation of ANR with PTA and impedance ( p = 0.002) was found. 71% abnormal PTA and tympanogram was found with ANR > 0.835 whereas 30.8% with ANR < 0.835. ANR is a useful adjunct as a pre-operative tool for determining the need for adenoidectomy in paediatric patients who are not easily willing to undergo endoscopic evaluation. A major drawback is the lack of identification of lateral extent of adenoids.