Posterior nasal nerve neurectomy for the treatment of chronic rhinosinusitis with nasal polyposis: a randomized controlled trial.

BACKGROUND: Managing Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is always challenging due to the chronicity of the disease and its intractable course. Posterior nasal neurectomy (PNN) can be effective in alleviating symptoms of CRSwNP. MATERIALS AND METHODS: The study was conducted in a tertiary care referral hospital from August 2019 to April 2022. A total of 46 patients of CRSwNP were included (23 patients in the study and 23 in the control group). Patients in the study group underwent endoscopic sinus surgery (ESS) and PNN and patients in the control group with ESS. The symptoms and quality-of-life improvement were assessed at 1, 4, 12, and 24 weeks after the surgery. RESULTS: On intragroup analysis between the preoperative and postoperative scores (SNOT-22, RSDI and LK Score), we found a significant difference for each (p < 0.05). When the improvement of outcome scores was compared between the two groups, a significant difference was obtained for SNOT-22 and RSDI scores at 1 week and 4 weeks (p < 0.05). There was no significant difference found for the duration of surgery/complications between the two groups (p = 1.00). CONCLUSION: The PNN can be an effective add-on procedure in patients with CRSwNP in alleviating short-term control of the symptoms and the quality of life. A larger sample size with long-term follow-up may be required for a better understanding of the efficacy of the PNN in patients with CRSwNP.

Perioperative stroke in parapharyngeal space schwannoma: an unusual, dreaded complication.

BACKGROUND: Post-styloid parapharyngeal space tumours (PPS) have a notorious course owing to their anatomy and proximity to neurovascular bundles. Nerve injuries are usual outcomes in schwannomas. Our case is the first documented complication of contralateral hemiplegia occurring in the postoperative period in a benign PPS tumour. CASE REPORT: A 24-year-old presented with a swelling on the left lateral aspect of the neck, diagnosed as a PPS schwannoma. He underwent transcervical excision with mandibulotomy with extracapsular dissection of the tumour. Contralateral hemiplegia, as a dreaded complication, was encountered. He was managed conservatively according to ASPECTS stroke guidelines by the critical care team. On a regular follow-up, he noticed an improvement in the lower limb with subsequent upper limb power. CONCLUSION: Perioperative stroke is a dreaded complication involving PPS in large benign tumours. To prevent unforeseen circumstances, necessary preoperative patient counselling and immense intraoperative care should be taken while dissecting the major vessels.

Partial Extracorporeal Septoplasty in Crooked Noses.

BACKGROUND: In crooked noses, the standard septoplasty is a challenge because of the complex deviation of the septum, where straightening of the cartilage in situ is impossible. Hence, it is required to remove the partial/total septum and later is replaced back after being straightened; the procedure is called partial/total extracorporeal septoplasty. In the present study, we shared our experience of partial extracorporeal septoplasty in patients with crooked noses. MATERIALS AND METHODS: It is a retrospective analysis of 30 crooked noses who underwent extracorporeal septoplasty due to gross septal deviation from March 2020 to August 2022. The functional and aesthetic outcomes were evaluated at the end of 12 months. RESULTS: Of 30 cases, partial and total extracorporeal septoplasty was performed in 28 cases and two cases respectively. Neoseptum was reconstructed with septal cartilage in 27 (90%) cases, costal cartilage in one case and conchal cartilage was used in two instances. All the patients had good functional and aesthetic outcomes till 12 months of follow-up, and there were no major intraoperative or postoperative complications. CONCLUSION: Extracorporeal septoplasty can be an excellent surgical procedure in the highly deviated nasal septum, in Indian noses with a crooked nasal deformity. It provides adequate exposure to the whole septum, ensuring good functional and aesthetic outcomes with minimal complication rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Changing trend in the management of head neck cancers during the COVID-19 pandemic.

BACKGROUND: In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19. MATERIALS AND METHODS: Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery. RESULTS: Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps. CONCLUSION: Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.

Comparison of efficacy of potassium titanyl phosphate laser & diode laser in the management of inferior turbinate hypertrophy: A randomized controlled trial.

Background & objectives: Inferior turbinate hypertrophy (ITH) is a common condition causing nasal obstruction. This study was undertaken to compare the efficacy of potassium titanyl phosphate (KTP) laser and diode laser in the reduction of the turbinate size. Methods: This randomized controlled trial included 209 patients with ITH. Pre-operative symptoms were assessed based on the Nasal Obstruction Symptom Evaluation (NOSE) score. Diagnostic nasal endoscopy was done to rule out other nasal sinuses. Nasal mucociliary clearance was measured by saccharin transit time (STT). Postoperatively, the NOSE score, STT and complications were assessed at days one and two, at one week, one month and three months. Results: Of the 209 patients analyzed at day one, the median NOSE score was 50 in the diode group and 40 in the KTP group, and at three months, 15 in the diode group and five in the KTP group. KTP laser showed a 93 per cent improvement in the NOSE score as compared to 77 per cent improvement shown by diode laser group. Among the intra-operative complications, of the 104 patients in the diode group, 6.73 per cent had burning sensation and 91.43 per cent had bleeding, and of 105 patients in the KTP group, 54.29 per cent had burning sensation and 36.54 per cent had bleeding. Among the post-operative complications in the KTP group, 32 and 34 per cent had bloody nasal discharge on days one and two, compared to 12 and 14 per cent in diode group. Crusting was present in 61 and 49 per cent on days one and two in KTP group as compared to 9 and 15 per cent in diode group, respectively. In the KTP group 30 per cent had synechiae as compared to 10 per cent in diode group. Interpretation & conclusions: KTP laser was more efficacious than diode laser in improving the NOSE scores but with slightly increased rate of complications in early post-operative period. Both the lasers impaired the mucociliary clearance mechanism of the nose till three months of post-operative follow up.

Comparison of middle ear function and hearing thresholds in children with adenoid hypertrophy after microdebrider and conventional adenoidectomy: a randomised controlled trial.

BACKGROUND: Microdebrider has superior efficacy in clearing the adenoids, compared to curettage. We compared the improvement in middle ear function and hearing thresholds after adenoidectomy, by both methods. MATERIALS AND METHODS: 126 patients (median age-9 years) were randomized into groups A and B, where adenoidectomy was done by microdebrider and curettage, respectively. Middle ear function parameters and hearing thresholds were measured serially. RESULTS: The mean improvement in middle ear pressure, compliance and hearing thresholds were 92.5 ± 67.6 and 84.2 ± 71.4 daPa; (p = 0.40), 0.19 ± 0.34 and 0.27 ± 0.27 mL; (p = 0.07) and 3.20 ± 4.95 and 2.54 ± 3.98 dB; (p = 0.27), in groups A and B, respectively. Reversal of type B tympanograms was noted in both groups. CONCLUSIONS: Middle ear function and hearing thresholds improved in both groups after adenoidectomy. More improvement was noted in the microdebrider group, which, however, was not significant.

Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction.

Background: Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. Materials and Methods: This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Results: Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37 min in the Endoscopic group and 91.92 ± 15.35 min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Conclusion: Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04184-4.

Use of Dormia Basket for Retrieval of Tracheobronchial Foreign body.

Background: It is always challenging to remove a long-standing smooth spherical foreign body through standard optical forceps. These foreign bodies do not negotiate with the traditional optical forceps and the chance of dislodgement during the surgery is high. Instead, a Dormia basket can be effectively used to remove these foreign bodies. Case report: We have reported two cases of smooth spherical bronchial foreign bodies, which were failed with the standard optical forceps and later successfully retrieved with a Dormia basket. Conclusion: Dormia basket can be effectively used to remove smooth spherical bronchial foreign bodies in children not amenable to the standard bronchoscopic forceps and later can be added to the standard tool in the foreign body retrieval kit for the otolaryngologist who deals with rigid bronchoscopy on a routine basis.

A Review on the Nasal Microbiome and Various Disease Conditions for Newer Approaches to Treatments.

Introduction: Commensal bacteria have always played a significant role in the maintenance of health and disease but are being unravelled only recently. Studies suggest that the nasal microbiome has a significant role in the development of various disease conditions. Search engines were used for searching articles having a nasal microbiome and disease correlation. In olfactory dysfunction, dysbiosis of the microbiome may have a significant role to play in the pathogenesis. The nasal microbiome influences the phenotype of CRS and is also capable of modulating the immune response and plays a role in polyp formation. Microbiome dysbiosis has a pivotal role in the development of Allergic Rhinitis; but, yet known how is this role played. The nasal microbiome has a close association with the severity and phenotype of asthma. They contribute significantly to the onset, severity, and development of asthma. The nasal microbiome has a significant impact on the immunity and protection of its host. The nasal microbiome has been a stimulus in the development of Otitis Media and its manifestations. Studies suggest that the resident nasal microbiome is responsible for the initiation of neurodegenerative diseases like Parkinson's Disease.Materials and Methods: Literature search from PubMed, Medline, and Google with the Mesh terms: nasal microbiome AND diseases. Conclusion: With increasing evidence on the role of the nasal microbiome on various diseases, it would be interesting to see how this microbiome can be modulated by pro/pre/post biotics to prevent a disease or the severity of illness.

Laryngeal Cellular Myxoma Presenting as Vocal Polyp.

Laryngeal myxoma is an uncommon benign mesenchymal neoplasm. It usually presents as a laryngeal polyp with a history of progressive hoarseness. Although benign, they have a propensity for recurrence if not excised properly. The diagnosis of laryngeal myxoma can only be rendered after histopathological evaluation. The laryngeal myxoma can be further classified as cellular myxoma and angiomyxoma, depending on the stromal cellularity and stromal vascularity, respectively. Herein, we report a case of a 66-year-old lady who presented with a cellular myxoma of the larynx. We believe that this is the second case of laryngeal cellular myxoma. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03291-y.

Endoscopic Repair of CSF Rhinorrhea: Our Experience at a Tertiary Centre.

Spontaneous or post-traumatic CSF (cerebrospinal-fluid) rhinorrhea occurs when there is a skull-base defect. In our study, we tried endoscopic approach, exclusively as surgical modality. To study feasibility of trans-nasal endoscopic approach for repair of skull-base defects and success rates at each anatomical subsite, with complications. Patients, who underwent endoscopic repair of CSF rhinorrhea between 2016 and 2019 were recruited into study. Details of investigative work-up, aetiology, surgery done, site of leak, number of surgical procedures done, post-operative complications and their management, success rate for each anatomical sub-site, was retrieved retrospectively and analyzed. All patients were initially managed with conservative measures before taking up for surgery. Eighteen-patients (male-11, female-7, mean age-40.3 years) with CSF rhinorrhea {spontaneous-5(27.7%), traumatic-13(62.3%)} were found. Sites of leak were cribriform-plate (CP), fovea-ethmoidalis (FE) and posterior-table of frontal-sinus (FS) in 8(44.4%), 5(27.7%) and 5(27.7%) respectively. Twelve (66.6%) patients had no postoperative complications. No patients with defects in CP had post-operative complication. Two (11.1%) patients with FS defect had meningitis, one (5.5%) patient with FS defect developed pneumocephalus. One (5.5%) patient developed frontal sinusitis at end of 4-months. Two (11.1%) patients, each with defects in FE and FS needed a revision repair on postoperative day 0 and 90-till date, none of the patients have any delayed procedure related complications or recurrences. Endoscopic repair of CSF leaks is the norm of the current day due to its minimally invasive nature. However, endoscopic repair of leaks through the frontal sinus were challenging and was associated with a high rate of complications.

Exclusive Endoscopic Approach in the Management of Sinonasal Inverted Papilloma.

Background: With the advancement in endoscopic endonasal surgeries, there has been a change in the surgical approach from the traditional open surgeries to the more conservative endoscopic endonasal approach for the management of sinonasal inverted papilloma. In the present study, we have shared our experience of endoscopic excision inverted papilloma involving the paranasal sinuses in a tertiary care hospital. Materials and methods: It is a retrospective case series of 28 patients who underwent endoscopic excision of inverted papilloma of paranasal sinus in a tertiary care hospital from April 2017 to October 2020. The medical records were retrospectively analyzed for the clinical, radiological, pathological, intraoperative and postoperative findings and later compared among the surgical approaches. Results: Of the total of 28 patients with inverted papilloma (3; Krouse 2 and 25; Krouse 3), 11(21.4%) patients were operated through endoscopic modified Denker, 8(39.3%) patients with endoscopic medial maxillectomy and 6(21.4%) patients with endoscopic sinus surgery. Patients who underwent modified endoscopic approach had lesser complications compared to the standard endoscopic procedures. Conclusion: Endoscopic excision of the sinonasal inverted papilloma can be a valid alternative to the open surgical approach, enabling complete clearance of the disease with a minimal complication rate. A large population with a long-term follow-up may be needed for a better understanding of the results. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03332-6.

Newborn Hearing Screening with Two-Step Protocol and Risk Factor Identification: Our Experience at a Tertiary Care Centre in Eastern India.

Objective: To estimate the prevalence of hearing loss and identify the high-risk factors among neonates with hearing loss. Methods: Retrospective study done on 1054 infants in a tertiary care centre in Eastern India from 2020 to 2021 and approved by the Institutional Ethics Committee. A two-step protocol is used for screening. In the well-nursed group, OAE and BOA were performed. In the case of REFER results for automated ABR following OAE evaluation in well-nursed babies, a detailed audiological evaluation was scheduled to be carried out using diagnostic ABR within one month of age. In the high-risk group, hearing screening includes OAE, BOA, and AABR evaluations. AABR evaluation was performed as a part of the screening protocol irrespective of the results of OAE screening as PASS or REFER. Results: In our study among 1053 neonates screened, 375 were in the risk category, and 679 were without risk factors. The overall prevalence of hearing loss in neonates was 22.78 per 1000 screened neonates and 56 per 1000 among high-risk neonates. In the high-risk group, we were able to identify 4 cases of Auditory spectrum neuropathy disorder with the use of AABR during 1st step of screening. In multivariate regression analysis, the risk factors for hearing loss identified were NICU stay (OR = 3.6, 95% CI = 1.1-12.03) and Craniofacial anomalies (OR = 55.37, 95% CI = 16.48- 186.01). Conclusion: Early neonatal screening helps in the detection, intervention, and rehabilitation of hearing loss. The use of AABR in risk infant screening enhanced the chance of detection of auditory spectrum neuropathy disorder (ASND) cases. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03723-3.

Carotid Body Tumors: Institutional Experience of 10 Cases and a Review of Literature.

Carotid body tumors are slow growing neck masses that arise from the neural crest cells at the carotid bifurcation. Majority are asymptomatic and are diagnosed incidentally. Surgical excision is accepted as the treatment of choice to reduce complications. In the present series, we report 10 cases of carotid body tumors and our institutional experience. All patients underwent radiological evaluation with an ultrasonography with Doppler, contrast enhanced computed tomography and MR angiography. 6 cases were operated by a transcervical excision. The tumor was excised in tototranscervically. One of the cases required saphenous vein graft intraoperatively due to vascular injury and also had postoperative vocal cord palsy. The rest had an uneventful recovery. Carotid body tumors although rare and seemingly indolent can cause substantial symptoms if left untreated. A prompt multi modality approach is needed for both diagnosis and treatment to avoid major complications.

Comparing accuracy of cochlear measurements on magnetic resonance imaging and computed tomography: A step towards radiation-free cochlear implantation.

Objective: Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are commonly employed in pre-operative evaluation for cochlear implant surgery. However, with a decrease in the age of implantation, even minor radiation exposure can cause detrimental effects on children over their lifetime. The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation. Methods: A longitudinal observational study was conducted on 94 ears/47 children, employing CT and MRI scans. The CT and MRI scan measurements include, A value, B value, Cochlear duct length (CDL), two-turn cochlear length, alpha and beta angles to look for cochlear orientation. Cochlear nerve diameter was measured using MRI. The values were compared. Results: The mean difference between measurements from CT and MRI scans for A value, B value, CDL, and two-turn cochlear length values was 0.567 ± 0.413 mm, 0.406 ± 0.368 mm, 2.365 ± 1.675 mm, and 2.063 ± 1.477 mm respectively without any significant difference. The alpha and beta angle measures were comparable, with no statistically significant difference. Conclusion: The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population. There is no significant difference between the measurements obtained from CT and MRI scans. However, observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery. This aspect must be addressed to ensure positive outcomes for patients.

Efficacy of Balloon Tamponade Versus Merocel Nasal Packs in Endoscopic Sinonasal Surgery: A Randomized Controlled Study.

Although absorbable nasal packings have been abundantly used in the recent time, the conventional packings are still used in different sinonasal surgeries in the various parts of the globe due to their lower cost. To compare the effectiveness of the balloon tamponade (Rapid Rhino) with Merocel nasal pack in sinonasal diseases. This study was conducted from July 2018 to July 2019 in a tertiary care referral hospital. Rapid Rhino and Merocel were put in 30 patients and 31 patients, respectively. Pain, bleeding, and mucosal healing was evaluated and compared between two groups postoperatively. The reduction in the pain and postoperative bleeding was significant with balloon tamponade (Rapid Rhino) compared to the Merocel (p < .05). Although insignificant (p > 0.05), patients with balloon tamponade nasal packs had less crusting and synechia in the postoperative period. Balloon tamponade (Rapid Rhino) nasal pack can be a better alternative to the Merocel nasal pack in reducing postoperative pain, bleeding, and mucosal damage.

Efficacy of endoscopic repair for CSF otorrhoea in children with recurrent meningitis due to incomplete partition type 1.

OBJECTIVE: To review the efficacy of endoscopic management with or without cochlear implantation in a pediatric population presenting with recurrent meningitis due to inner ear incomplete partition type 1 (IP-1). MATERIALS AND METHODS: A multicentric report of 6 patients with a history of recurrent meningitis due to IP-1 was done. Radiological evaluation was performed to confirm the diagnosis. Transcanal endoscopic repair of the defect was performed in 3 cases, 2 cases underwent endoscope-assisted repair followed by cochlear implantation in the contralateral ear later, and 1 patient underwent endoscopic repair along with simultaneous cochlear implantation. RESULTS: Radiology confirmed the diagnosis and identified the site of the leak. A leak was detected in all cases from the stapes footplate. Two patients with unilateral deformity had a CSF-filled cyst protruding through a defect in the stapes footplate, and the rest of the four had a high flow CSF leak from the footplate. Five patients who underwent repair have had no further episodes of meningitis. One patient who received simultaneous implantation and repair developed postoperative meningitis managed successfully with antibiotics. CONCLUSION: Hearing loss due to inner ear deformity can be easily missed as a cause for recurrent meningitis, especially if unilateral. A high index of suspicion, audiological screening and radiology are essential to clinch the diagnosis. In such cases, a pure endoscopic or endoscopic assisted transcanal approach to repair CSF otorrhoea is an effective alternative to more radical procedures like subtotal petrosectomy with obliteration. In patients with bilateral profound hearing loss, simultaneous cochlear implantation and repair of the defect can be performed successfully.

Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancers: Our Experience in 29 Cases.

Purpose: To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap and deltopectoral flap (DP) in advanced oral cavity cancers in the Indian population. Materials and Methods: It is a retrospective study, considering 29 patients with stage IV carcinoma of the oral cavity, from July 2015 to February 2019. Both pectoralis major Myocutaneous flaps and deltopectoral flaps were used for stage IV oral cancers involving the full-thickness cheek and the mandibular cortex. The reliability of the flaps and clinical outcomes were evaluated in the postoperative period. Results: Of the 29 patients, partial necrosis of the skin island was detected in 6 patients, 2 patients presented with wound dehiscence, and one patient had an orocutaneous fistula. Recurrence was detected in 3(10.34%) patients, in one patient, it was at the primary site and in 2 patients, it was in the neck. When different parameters were compared between the patients with complications and without complications, the comorbidities like smoking and alcohol intake adversely affected the flap survival in the postoperative period. Conclusions: The combined use of PMMC and DP flap can be a reliable option for advanced oral malignancies, especially in patients with poor performance status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, these pedicle flaps can be successfully used alternative to the free flaps in advanced oral cancers, especially patients with a low socioeconomic corridor like India.