Laryngeal schwannoma masquerading as malignancy.

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.

Primary Thyroid Lymphoma Diagnosed on Rapid Onsite and Cytology: A Rare Case Report.

Introduction: Rapid on-site evaluation (ROSE) is an essential component of thyroid cytopathology, particularly important in thyroid lymphoma, anaplastic carcinoma, metastasis to avoid unnecessary surgery. Follicular epithelial neoplasms are the most common tumors arising from the thyroid, whereas primary thyroid lymphomas are uncommon, accounting for less than 5% of all thyroid malignancies. Case description: A 45-year-old male patient presented to our ENT outpatient department with swelling in the anterior neck for 3 years duration. Non-aspirational needling was done along with rapid on-site evaluation using 1% aq. toluidine blue and was reported as Malignant thyroid neoplasm- possibility of Non-Hodgkin lymphoma (NHL). Cellblock sample also confirmed as B-cell NHL followed by Immunohistochemistry. Discussion: Primary thyroid lymphomas (PTL) are uncommon malignant neoplasms. They represent < 5% of all thyroid malignancies and 1-2% of all extra-nodal lymphomas. If diagnosed cytologically, unnecessary surgery can be avoided in thyroid lymphoma. ROSE helps in the rapid diagnosis and sample adequacy. Cellblock can avoid the biopsy procedure used for confirmation and subtyping of lymphoma.

Nasal Mucormycosis: Our experience with 24 cases.

<b>Background:</b> Mucormycosis is a rare fungal infection affecting people with impaired immunity. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with mucormycosis hospitalized at a tertiary care center in Pondicherry. <br><b>Methods:</b> We conducted a retrospective chart review between January 2008 and January 2018. All patients with proven or probable mucormycosis were included. <br><b>Results:</b> A total of 24 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. <br><b>Conclusion:</b> The incidence of mucormycosis has significantly increased over the past 10 years at our institution, most likely due to increased risk factors.

A Randomized Study on the Efficacy of Music Therapy on Pain and Anxiety in Nasal Septal Surgery

Abstract Introduction Nasal septal surgery is one of themost common surgeries performed by otolaryngology surgeons; however, anxiety before surgery and postoperative pain remain a significant cause of morbidity. The search for a complimentary modality to reduce the symptoms and side effects has gained momentum in recent years. Objective Music therapy is an exciting and inexpensive modality in this regard, but scientific evidence in terms of randomized clinical trials is still lacking for common otolaryngology surgeries. Hence, we performed the present study. Method The sample of our study was composed of 59 patients, 30 of which were submitted to conventional medicine, while the remaining 29 were submitted to both conventional medicine and music therapy with music of their own choice, with 2 sessions per day, each lasting 30minutes. This was performed using the generalized anxiety disorder-7 scale and the pain visual analogue scale until postoperative day 2, when the patients were discharged from the hospital. Result On comparing the anxiety and pain scores between the two groups, the group who underwent music therapy showed a statistically significant reduction in anxiety both preoperatively (p<0.0001) and postoperatively (p<0.0001), as well as reduced postoperative pain starting from day 0 (p<0.001), which continued until postoperative day 2 (p<0.001). Conclusion Music therapy is an effective adjunct in the control of anxiety and postoperative pain following nasal septal surgery.

A Randomized Study on the Efficacy of Music Therapy on Pain and Anxiety in Nasal Septal Surgery.

Introduction Nasal septal surgery is one of the most common surgeries performed by otolaryngology surgeons; however, anxiety before surgery and postoperative pain remain a significant cause of morbidity. The search for a complimentary modality to reduce the symptoms and side effects has gained momentum in recent years. Objective Music therapy is an exciting and inexpensive modality in this regard, but scientific evidence in terms of randomized clinical trials is still lacking for common otolaryngology surgeries. Hence, we performed the present study. Method The sample of our study was composed of 59 patients, 30 of which were submitted to conventional medicine, while the remaining 29 were submitted to both conventional medicine and music therapy with music of their own choice, with 2 sessions per day, each lasting 30 minutes. This was performed using the generalized anxiety disorder-7 scale and the pain visual analogue scale until postoperative day 2, when the patients were discharged from the hospital. Result On comparing the anxiety and pain scores between the two groups, the group who underwent music therapy showed a statistically significant reduction in anxiety both preoperatively ( p < 0.0001) and postoperatively ( p < 0.0001), as well as reduced postoperative pain starting from day 0 ( p < 0.001), which continued until postoperative day 2 ( p < 0.001). Conclusion Music therapy is an effective adjunct in the control of anxiety and postoperative pain following nasal septal surgery.

Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C.

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6 months, 1 and 2 year. Success rate was 100% at 3 and 6 months follow-up in both the groups. At the end of 1 year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3 months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure. Level of evidence Individual prospective cohort study, level 1b.

Demystifying autoimmune inner ear disease.

INTRODUCTION: Autoimmune inner disease (AIED) is an uncommon cause of sensorineural hearing loss and poses a diagnostic challenge. The present study aims to review the existing knowledge on the clinicopathological aspects, the diagnostic challenges, and therapeutic interventions in AIED. DISCUSSION: The incidence of AIED is less than five cases per 100,000 population. There are no definite seromarkers which make diagnosis of AIED difficult. Even though various markers have been studied, their sensitivity and specificity have not been replicated in the clinical scenario. The treatment of the condition is also an enigma. Corticosteroids are the drug of choice and require long-term use to prevent relapse. Various other therapeutic agents have been studied in a small cohort of patients, but the efficacy of these drugs needs to be validated in a large multicentric trial. CONCLUSION: Timely intervention can restore hearing loss in AIED patients, but the clinician has to find a delicate balance between the hearing outcome and the potential side effects resulting from long-term use of the drugs. Treatment of steroid resistant AIED is a challenge and there are no universal guidelines for the same. AIED being an uncommon diagnosis, multicentric trials and collaboration are required to formulate diagnostic criteria and therapeutic guidelines.