A Peculiar Case of Isolated Bilateral Tympanic Plate Fractures.

Tympanic plate fractures are uncommon injuries and carry the risk of external auditory canal stenosis. These injuries are often associated with fractures of adjacent bones like the mandible, maxilla, and temporal bone. Isolated bilateral tympanic bone fractures have rarely been reported. The most frequently advocated treatment for these injuries is surgical to prevent canal stenosis in the future. The effectiveness of non-operative management has been seldom reported. In the current case report, we present an uncommon injury with isolated bilateral tympanic plate fractures secondary to trauma to the mandible with no associated mandible or condylar fractures that were treated non-operatively. The functional outcomes were favorable at one year of follow-up.

Sensorineural Hearing Loss in Unilateral Mucosal Type of Chronic Otitis Media.

Sensorineural hearing loss is relatively well established in the squamosal chronic otitis media. However, its association with mucosal COM is still debated. The present study aimed at evaluating the prevalence of sensorineural hearing loss in unilateral mucosal COM. The study was conducted at a tertiary care hospital in New Delhi, and 60 patients with unilateral mucosal chronic otitis media were recruited. Pure tone thresholds were ascertained for air and bone conduction in an acoustically treated room and matched against certain patient and disease characteristics. In this study, the combined prevalence of SNHL/Mixed Hearing loss in mucosal COM was found to be 8.3%. A statistically significant association between SNHL/Mixed HL was seen in the 40-50-year age group (p-0.004). Prevalence with a disease duration of more than 10 years was 33% (p-0.019). All the patients who presented with SNHL/Mixed HL had an actively discharging ear. 80% of the patients who presented with SNHL/Mixed HL had large perforations. SNHL/Mixed HL prevalence of 28.6% was found in smokers, compared to 5.7% in non-smokers (p-0.039). The risk of developing SNHL/Mixed HL increased with increasing patients' age, disease duration, and size of the perforation and smokers.

Association of human papillomavirus and Epstein-Barr virus with squamous cell carcinoma of upper aerodigestive tract.

Background: Cancers of the upper aero-digestive tract (UADT) are fifth most common cancer in the world with around 10,55,000 new cases and 7,25,000 deaths worldwide. Tobacco and alcohol act synergistically and are the two most important etiological factors responsible for about 75% of SCC. Studies have reported changing trends in the incidence of SCC showing an increasing shift in epidemiology attributed to the infection by viruses. The most commonly implicated viruses are the Human Papillomavirus (HPV) and Epstein-Barr virus (EBV). Aim and Objective: To study association of Human Papilloma virus (HPV) and Epstein Barr virus (EBV) with 100 newly diagnosed cases of squamous cell carcinoma (SCC) of upper aerodigestive tract (UADT) and correlate its association with clinical parameters, histomorphological grade and staging using immunohistochemical markers p16, LMP1, p53, p63. Materials and Methods: The study was conducted in the department of Pathology, Maulana Azad medical college and associated hospitals, New Delhi from September 2018-April 2019. Specimens was routinely processed. Immunohistochemistry (IHC) was done using p16, LMP1, p53, p63 monoclonal antibodies. Statistical Analysis Used: SPSS 20 software. The quantitative analysis was done using Pearson chi-square test. Probability values < 0.05 was be considered statistically significant. Results: HPV was present in 29% cases while EBV in 38% cases. Oral cavity was the most common site involved by both HPV and EBV. Co-infectivity was found in 4% cases. There was significant male predominance in both. HPV was more prevalent in age >45 years while EBV was equally distributed in <45 years and >45 years. Moderately differentiated squamous cell carcinoma was the commonest grade involved by both the viruses. A significant correlation was found between EBV and alcohol. p53 positivity had an inverse relationship with HPV positivity. P63 expression was higher in HPV and EBV positive cases. Conclusion: In resource constraint settings, p16 and Latent membrane protein 1 can be used as surrogacy markers for Human Papilloma virus and Epstein Barr virus along with p53 and p63 for its association with histomorphological grade and stage.

Preoperative platelet-lymphocyte ratio and neutrophil-lymphocyte ratio as predictors of occult lymph node metastasis detected using Desmoglein 3 and Cytokeratin in Indian population.

Aim: This study aims to assess whether preoperative platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) can predict occult metastasis in oral squamous cell carcinoma (OSCC). Materials and Methods: Thirty-five OSCC cases were analyzed for clinicopathological and hematological data. Cases without metastasis (pN0) were checked for micrometastasis immunohistochemically using Desmoglein 3 (DSG3) and Cytokeratin (CK). Mean PLR and NLR were compared and analyzed between the study groups. Results: Metastatic deposits were detected in 9 out of 26 pN0 cases (34.6%) accounting for 11 out of 62 (17%) lymph nodes subjected to immunohistochemistry. The mean PLR was higher in OSCC cases with or without occult metastasis in comparison to controls (P < 0.001). No significant difference was found in the mean PLR and NLR between OSCC cases with and without occult metastasis. Furthermore, we found DSG3+ sinus histiocytes within the lymph nodes in majority of cases which is least reported in literature. Conclusion: A significant percentage of cases showed occult metastasis in this study which led to upstaging of tumor. Although PLR was elevated in OSCC cases, it did not have a positive correlation with the presence of occult metastasis but was able to successfully distinguish OSCC patients from healthy individuals.

High-resolution computed tomography evaluation of congenital aural atresia - how useful is this?

OBJECTIVE: To depict various temporal bone abnormalities on high-resolution computed tomography in congenital aural atresia patients, and correlate these findings with auditory function test results and microtia subgroup. METHODS: Forty patients (56 ears) with congenital malformation of the auricle and/or external auditory canal were evaluated. Auricles were graded according to Marx's classification, divided into subgroups of minor (grades I and II) and major (III and IV) microtia. Other associated anomalies of the external auditory canal, tympanic cavity, ossicular status, oval and round windows, facial nerve, and inner ear were evaluated. RESULTS: Minor and major microtia were observed in 53.6 and 46.4 per cent of ears respectively. Mean hearing levels were 62.47 and 62.37 dB respectively (p = 0.98). The malleus was the most commonly dysplastic ossicle (73.3 vs 80.8 per cent of ears respectively, p = 0.53). Facial nerve (mastoid segment) abnormalities were associated (p = 0.04) with microtia subgroup (80 vs 100 per cent in minor vs major subgroups). CONCLUSION: Microtia grade was not significantly associated with mean hearing levels or other ear malformations, except for external auditory canal and facial nerve (mastoid segment) anomalies. High-resolution computed tomography is essential in congenital aural atresia, before management strategy is decided.

Clinicopathological correlation of tumor-stroma ratio and inflammatory cell infiltrate with tumor grade and lymph node metastasis in squamous cell carcinoma of buccal mucosa and tongue in 41 cases with review of literature.

INTRODUCTION: Several studies regarding tumor-stroma ratio (TSR) in colorectal, esophageal, breast, endometrial, and cervical carcinomas have been done in the past with significant results. OBJECTIVES: The objectives of this study were to (1) study and grade TSR in buccal mucosa and tongue squamous cell carcinoma (SCC), (2) grade inflammatory cell infiltrate surrounding the tumor, and (3) correlate the above two parameters with tumor grade, lymph node metastasis, lymphovascular invasion (LVI), and perineural invasion (PNI). MATERIALS AND METHODS: Totally, 25 patients of buccal SCC and 16 cases of tongue SCC were included in the study. TSR was assessed visually on the hematoxylin and eosin-stained tissue sections by two independent observers. Cases were categorized into two groups: One with high TSR >50% (stroma poor) and the other with low TSR <50% as the stroma-rich group. TSR was correlated with tumor size, lymph node metastasis, inflammatory cell infiltrate, LVI, and PNI. Data were analyzed by the Statistical Package for the Social Sciences version 16.0 (Chicago, IL, USA) for Windows. The Chi-square and Fischer's exact tests were applied in the analysis of categorical variable. RESULTS AND CONCLUSION: SCC of buccal mucosa showed a significant correlation between TSR and size of the tumor (P = 0.001). We found that smaller the tumor size ≤2 cm (Stage T1), lesser the TSR, and size >2 cm was found to be associated with higher TSR. Hence, higher TSR (stroma poor) was associated with an adverse pathological characteristic, i.e., advanced T significantly. There was no significant correlation between TSR and inflammatory infiltrate with grade of the tumor, lymph node metastasis, LVI, and PNI. In 16 cases of SCC of the tongue; no correlation was observed between TSR and inflammatory infiltrate with tumor size, grade of the tumor, lymph node metastasis, LVI, and PNI. TSR has been studied in various malignancies (mostly adenocarcinomas) including laryngeal SCCs; however, it has never been studied on oral SCCs.

Challenges in Preparing and Managing the Critical Care Services for a Large Urban Area During COVID-19 Outbreak: Perspective From Delhi.

The coronavirus disease-2019 (COVID-19) pandemic has put healthcare services all over the world into a challenging situation. The contagious nature of the disease and the respiratory failure necessitating ventilatory care of these patients have put extra burden on intensive care unit (ICU) services. India has been no exception; by March 2020, the number of COVID-19 patients started increasing in India. This article describes the measures taken and challenges faced in creating ample ICU bed capacity to cater to the anticipated load of patients in the state of Delhi, India, as a result of the COVID-19 pandemic. The main challenges faced, among others, were estimating the number of ICU beds to be created; deciding on dedicated hospitals to treat COVID-19 patients; procuring ventilators, personal protective equipment, and other related material; mobilizing human resources and providing their training; and providing isolated in-house accommodations to the staff on duty. The authors acknowledge and agree that the methodology proposed in this article is but one way of approaching this difficult scenario and that there could be other, perhaps better, methods of dealing with such a problem.

Endoscopic visualisation of the round window during cochlear implantation.

BACKGROUND: Endoscopes provide a magnified view of the middle ear and visualisation of hidden areas. Otoendoscopes facilitate excellent visualisation of the round window niche during cochlear implantation. OBJECTIVE: To compare microscopic and endoscopic visualisation of the round window membrane during cochlear implantation in 20 patients. METHODS: Twenty patients who underwent cochlear implantation were included in the study. After maximum exposure of the round window, the accessibility of the round window membrane was graded according to the St Thomas Hospital classification, first by microscope and then by endoscope. RESULTS: With the use of the endoscope, visualisation of the round window membrane improved in all the patients as compared to the microscope. The electrode array was inserted via a round window or extended round window approach in all but two cases; the latter cases required bony cochleostomy because of unfavourable anatomy. CONCLUSION: The main benefit of endoscope-assisted cochlear implantation is improved visibility of the round window region.

Laryngocele: A Rare Case Report and Review of Literature.

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

Internal Carotid Artery Bleed: A Rare Complication of Invasive Sphenoidal Aspergillosis.

BACKGROUND: Invasive sinonasal aspergillosis is rarely seen in immunocompetent individuals. It may involve adjacent intracranial and intraorbital structures causing high morbidity and mortality. CASE DESCRIPTION: We report a rare case of invasive Aspergillus sinusitis in a young, immunocompetent woman causing headache and vision loss. Endoscopic débridement under general anesthesia was complicated by rupture of a mycotic cavernous carotid artery aneurysm. This was managed by packing with muscle and fascia followed by endovascular coiling. Subsequently, the aneurysm extended intradurally and caused fatal subarachnoid hemorrhage. CONCLUSIONS: This case emphasizes the need for early diagnosis of invasive fungal sinusitis to prevent intracranial complications and fatal outcome. When the diagnosis is made, aggressive treatment with surgical débridement and adjuvant antifungal therapy is required. Internal carotid artery involvement is a rare but life-threatening complication of invasive fungal sinusitis.

Comparative evaluation of round window niche accessibility pre-operatively on high-resolution computed tomography of the temporal bone with intra-operative findings.

OBJECTIVE: To compare round window niche visibility as seen endoscopically during cochlear implant surgery with pre-operative high-resolution computed tomography of the temporal bone. METHODS: Nineteen patients scheduled for cochlear implantation, aged 2-20 years, were referred for computed tomography from October 2016 to March 2018. Angles were measured between the lines passing through the mid-sagittal plane and cochlear basal turn on the scans. Endoscopic round window niche visibility during posterior tympanotomy was categorised as: type I = 100 per cent, type IIa = more than 50 per cent, type IIb = less than 50 per cent or type III = 0 per cent. Pre-operative computed tomography measurements were used to predict round window niche visibility before surgery and correlated with intra-operative findings. RESULTS: The mean (range) of pre-operative angles on computed tomography for endoscopic visibility types I, IIa and IIb, were 64.06° (61.16-69.37°), 63.81° (58.61-71.35°) and 56.48° (50.37-59.05°), respectively, a statistically significant finding (one-way analysis of variance test, p = 0.016). CONCLUSION: Pre-operative high-resolution temporal bone computed tomography measurements are useful in predicting round window niche visualisation as viewed endoscopically during posterior tympanotomy. The angle was more acute in type IIb compared to type I.

Type 1 Tympanoplasty by Cartilage Palisade and Temporalis Fascia Technique: A Comparison.

(1) To compare graft take up of type-1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. (2) To compare hearing results of type 1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. A prospective clinical study. It consisted of 60 patients divided into two groups of 30 patients each. After randomization 30 patients underwent type 1 tympanoplasty using cartilage palisade technique and 30 underwent type 1 tympanoplasty using autotemporalis fascia. In follow up, pure tone audiogram were carried out at 2nd, 4th and 6th month. Clinical assessment was done at 2nd 4th and 6th month. The graft uptake rate between the group 1 and group 2 are 93.33 and 90% respectively. As p value was greater than 0.05 so statistically there is no significant difference between the two group. The post operative air bone gap of the two groups were compared using student t test. The pre op mean of group 1 was 32.5 db and pre op mean of group 2 was 30.66 db. The post op mean of group 1 was 21.33, with standard deviation of 3.6984 and standard error of 0.67523. The post op mean of group 2 was 21.09 with standard deviation of 3.29 and standard error of 0.58261. t value was 0.1357. Analysis was done using student t test and p value was found to be greater than 0.05. p value is greater than 0.05 which shows that there is no statistical difference between the two groups. This study establishes the fact that hearing results after performing type 1 tympanoplasty by autotemporalis fascia when compared with type 1 tympanoplasty performed by cartilage palisade technique showed similar hearing gain and post operatively graft take up rate was also similar in two groups. The disadvantage of reducing the mechanical vibration of the tympanic membrane was overcome by the palisade reconstruction of the tympanic membrane. This study definitely emphasizes upon usage of new grafting materials in reconstruction of tympanic membrane, with similar, if not better functional results, without compromising the acoustic transfer characteristics.

Intracranial complications of CSOM in pediatric patients: A persisting problem in developing countries.

BACKGROUND: Intracranial complications (ICC) of chronic suppurative otitis media (CSOM) occur even in the antibiotic area. These complications are commonly seen in pediatric patients due to poor hygiene and low immunity. They are more prevalent in developing countries due to illiteracy, low socioeconomic status and lack of access to health care facilities. OBJECTIVE: To study the incidence, clinical profile, treatment and outcome of pediatric patients presenting with intracranial complications of chronic suppurative otitis media. METHODS: A retrospective analysis of intracranial complications of CSOM in pediatric patients was conducted over a period of 15 years at a tertiary level institute. Data regarding age, sex, clinical presentation, laboratory and radiological investigations, management, duration of hospitalization, and outcomes were recorded. RESULTS: There were 142 patients, in the pediatric age group, diagnosed as having intracranial complications due to chronic otitis media during the study period. There was a decline in the incidence of ICC of CSOM. The most frequent intracranial complication seen was brain abscess (58.5%). All patients were administered intravenous antibiotics for 4-6 weeks and underwent canal wall down mastoidectomy. Neurosurgical intervention was considered in the required patients. The case fatality rate in our study was 2.8% (4 patients). CONCLUSION: Otogenic intracranial complications can be fatal if not managed appropriately and timely. Broad spectrum intravenous antibiotics are usually required for 4-6 weeks with or without neurosurgical intervention and mastoid exploration. A high index of suspicion is required in all patients presenting with danger symptoms.

Complicated coexisting pyogenic and tuberculous otitis media affecting the temporozygomatic, infratemporal, and parotid areas: report of a rare entity.

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.

Intraparotid facial nerve neurofibroma: an uncommon neoplasm / Neurofibroma intraparotídeo del nervio facial: una neoplasia poco frecuente

Intraparotid facial nerve neurofibromas are a rare entity, and are grossly and histopathologically distinct from the comparatively more prevalent schwannomas. We report a rare case of an intraparotid facial nerve neurofibroma with intratemporal extension in a 48-year-old female. The tumor was surgically excised with cable grafting of the facial nerve. Electroneurography may eventually assist in the preoperative diagnosis. Facial nerve resection should be more readily contemplated in a patient with neurofibroma than in a patient with schwannoma; however, facial nerve preservation with serial follow-up electroneurography and computerized tomography remains a viable option in patients with small facial nerve neurofibromas when electrical testing reveals minimal evidence of progressive neural degeneration. Close monitoring, especially in neurofibromas associated with Von Recklinghausen's disease, is mandatory because of an increased risk of sarcomatous degeneration.

Los neurofibromas intraparotídeos del nervio facial son una entidad poco frecuente, macroscópicamente e histopatológicamente diferentes de los comparativamente más frecuentes schwannomas. Se presenta un caso raro de un neurofibroma del nervio facial con extensión intraparotídea intratemporal en una mujer de 48 años de edad. El tumor se extirpó quirúrgicamente con injerto del nervio facial. La electroneurografía puede llegar a ayudar en el diagnóstico preoperatorio. La resección del nervio facial debe ser realizada con mayor facilidad en un paciente con neurofibroma que en un paciente con schwannoma, sin embargo, la preservación del nervio facial con electroneurografía de seguimiento y tomografía computarizada sigue siendo una opción viable en pacientes con pequeños neurofibromas del nervio facial, cuando las pruebas eléctricas revelan mínima evidencia de degeneración neuronal progresiva. Una estrecha vigilancia, especialmente en los neurofibromas asociados con la enfermedad de Von Recklinghausen es fundamental debido al aumento del riesgo de degeneración sarcomatosa.

Lymphangioma circumscriptum of the tongue: successful treatment using intralesional bleomycin.

OBJECTIVE: We report a case of lymphangioma circumscriptum of the tongue, a very rare site of occurrence, which was successfully managed with intralesional bleomycin therapy. METHOD: We present a case report and review of available literature regarding lymphangioma circumscriptum of the tongue and the role of bleomycin therapy. RESULTS: The patient was a 19-year-old man with a long-standing lesion involving the tongue, who presented with spontaneous, episodic bleeding over the previous few months. A diagnosis of lymphangioma circumscriptum was established on biopsy. Intralesional bleomycin injection resulted in successful resolution, and the patient remained asymptomatic over more than one year's follow up. CONCLUSION: Lymphangioma circumscriptum is usually seen in the extremities and genitals. This case had a very rare site of occurrence, the tongue, and was successfully managed with conservative treatment, using intralesional bleomycin alone.

Preoperative computed tomographic evaluation of inferior nasal concha hypertrophy and its role in deciding surgical treatment modality in patients with deviated nasal septum / Evaluación preoperatoria con tomografía computada de la hipertrofia de la concha nasal inferior y su rol en la decisión de la modalidad de tratamiento quirúrgico en pacientes con tabique nasal desviado

Deviated nasal septum is associated with compensatory hypertrophy of the inferior nasal concha on the contralateral side. In the past conventional septoplasty was done for the deviated septum, which would improve the patency on the side of deviation but would worsen it on the opposite side due to reallocation of the septum to the midline. The present study of 50 patients unfolds the anatomical composition of the inferior nasal concha based on the computed tomographic scan and help the otolaryngologist to determine whether to add turbinoplasty to standard septoplasty procedure or not.

Un tabique nasal desviado está asociado con una hipertrofia compensatoria de la concha nasal inferior del lado contra lateral. En el pasado se realizaba septoplastía convencional para el tabique desviado, lo que mejoraraba la permeabilidad en el lado de la desviación, pero agravaba ésta en el lado opuesto, debido a la reacomodación del tabique en el plano mediano. En el presente estudio se evaluó en 50 pacientes la composición anatómica de las conchas nasales inferiores, basado en la exploración a través de tomografía computarizada, y de esta manera ayudar al otorrinolaringólogo a determinar si es necesario o no, añadir la plastía de la concha nasal inferior al procedimiento de septoplastía estándar.

Coexistent acute pyogenic and tubercular petrous apicitis: a diagnostic dilemma.

We report the case of a 16-year-old boy who presented to us with acute otitis media, facial weakness and retro-orbital pain. Computed tomography and magnetic resonance imaging (MRI) scans of the head and temporal bone revealed otitis media with petrous apicitis. The patient responded to broad-spectrum, parenteral antibiotics, with disappearance of facial weakness and reduction in pain. One month following the completion of treatment, the patient continued to have dull retro-orbital pain and developed ear discharge. A repeat MRI of the temporal bone revealed a persistent inflammatory lesion in the petrous apex, with a nodular, ring-enhancing lesion in the cerebellum, strongly suggestive of tuberculosis. The ear discharge stained positive for acid-fast bacilli and the patient's serum enzyme-linked immunosorbent assay for tuberculosis was reactive. The patient responded well to anti-tubercular treatment and was disease free eight months following the completion of treatment.

Giant cell tumour (osteoclastoma) of the zygoma: an extremely unusual neoplasm.

We report an extremely rare case of a giant cell tumour of the zygomatic bone in a 36-year-old female. The tumour was excised with healthy margins. The patient is asymptomatic without any evidence of recurrence 14 months postoperatively. To our knowledge, this is only the third reported case of this tumour occurring in the zygomatic bone in the medical literature.

Cysticercosis of tongue - A case report.

Tongue is a rare site for cysticercosis cellulosae. Very few cases of solitary cysticercosis of tongue have been reported. We are reporting one such case. Also a review of reported cases in literature, etoipathogenesis, clinical course and management is being described.