Intraoral ultrasonography: an adjunct in oral onco-surgery.

OBJECTIVE: To determine the precision and accuracy of intraoral sonography in assessing the depth of invasion in oral cancer. MATERIAL AND METHODS: A prospective study was conducted in 30 cases of oral cancer. Subjects were subjected to computerised tomography and intraoral sonography before surgery. The depth of invasion assessed through clinical palpation and radiological tools was compared with surgical histopathology. RESULTS: The depth of invasion assessed on clinical palpation and computerized tomography had statistically significant difference with histopathology whereas intraoral sonography didn't show any difference. The intraoral sonography and computerised tomography had comparable precision and accuracy, with a slight dominance of the computerised tomography in assessing the tumor's depth of invasion greater than 4 mm. However, intraoral sonography was more precise and accurate than computerised tomography in assessing the depth of invasion beyond 10 mm. CONCLUSION: Intraoral sonography was found to be a reliable tool in the assessment of the depth of invasion in oral cancer. It can prove beneficial during surgery in achieving tumour-free surgical margins.

Sonographic and Cytological Evaluation of Salivary Gland Tumors.

INTRODUCTION: Salivary gland tumours are relatively uncommon, but they have a multifaceted clinical presentation and varied morphological configuration. The investigations required for these tumours remain debatable. We conducted a study to determine the accuracy of various modalities used in salivary gland tumours. METHODS: We enrolled 72 subjects, consisting of 44 females and 28 males, with a mean age of 40.93 ± 16.51 years (range: 15 to 79 years), suffering from various salivary gland tumours. The tumour distribution included 42 parotid gland tumours (58.33%), followed by 21 submandibular gland tumours (29.16%), three sublingual gland tumours (4.16%), and six minor salivary gland tumours (8.33%). These individuals were subjected to clinical examination, sonography, and fine needle aspiration cytology as per indications. The results of each modality were compared to surgical pathology to find sensitivity and accuracy. RESULTS: The clinical examination was found to be least sensitive (83.8%) as compared to FNAC (97.6%), and ultrasound (100%). Ultrasound had the highest diagnostic accuracy (86.2%) as compared to clinical examination (80.6%) and FNAC (82.6%). CONCLUSION: Although sonography was found to have the highest sensitivity and accuracy as compared to fine needle aspiration cytology and clinical examination, the difference was subtle, as both sonography and fine needle aspiration cytology had a statistically significant correlation with histopathology.

Long Term Health-Related Quality of Life with Differentiated Thyroid Cancer in Goiter Endemic Area.

Health related quality of life (HRQOL) is a multidimensional concept that encompasses the patient's perceptions of his or her physical, emotional, social, and cognitive functions. Despite DTC patients' long survival, HRQOL has been shown to be lower than in the general population. There is a scarcity of data on HRQOL in thyroid cancer in the Indian population and especially goiter endemic area. As a result, the authors conducted a health-related quality of life survey in patients managed at their center in Northern India's Sub-Himalayan region using two widely accepted questionnaires. Adults with differentiated thyroid cancer who had surgery with or without radio-iodine ablation and had recovered for at least 6 months were assessed using health quality of life surveys, the QLQ-C30 and QLQ-THY34 of the European Organization for Research and Treatment of Cancer Quality of Life Group. The survey was completed by 57 adults with a mean age of 45.64 ± 15.64 years. The average time between the survey and treatment was 13.3 ± 10.8 months. After surgery, the QLQ-C30 found a significant reduction in insomnia, appetite loss, constipation, diarrhea, and financial difficulties, whereas radio-iodine ablation significantly improved global health status. The QLQ-THY34 found a significant increase in symptoms such as voice concerns, hair problems, dry mouth, shoulder functioning, tingling, and worrying after surgery, with a significant improvement in swallowing and job impact symptoms. The surgical extent had no impact. The quality of life for people with differentiated thyroid cancer in goiter-endemic areas is similar to that of other areas. However, the limited number of subjects in the study warrants further large sample size longitudinal study to understand the exact Health-related quality of life in thyroid cancer in endemic area.

Is Laser Better than Cold Steel (Dissection and Snare) for Tonsillectomy?

OBJECTIVE: To analyse the surgical outcome of CO2 laser assisted tonsillectomy with the cold steel (conventional dissection and snare) tonsillectomy. MATERIALS AND METHODS: This prospective, non-randomised, single blind study was conducted in 25 cases suffering with recurrent tonsillitis. The left tonsillectomy was performed with CO2 laser while the right tonsil was excised using cold steel method (conventional dissection and snare method). The surgical time, blood loss and post-operative pain for each method was recorded and analysed. RESULTS: CO2 laser tonsillectomy had highly significant less intra-operative blood loss (41.8ml vs. 78.8ml with p = 0.001) and postoperative pain levels on postoperative day 1,3, and 5 ( p value of 0.013, 0.006 and 0.000 respectively) as compared to cold steel method. However; there was no statistically significant difference in operative time between the two techniques (p > 0.05). CONCLUSION: CO2 laser tonsillectomy appeared to be better technique than cold steel in terms of intra-operative haemorrhage and pain.

Covid 19 Associated Idiopathic Intracranial Hypertension and Acute Vision loss.

Headache is a frequent complaint in COVID-19 while intracranial hypertension leading to acute vision loss is unusual. A 49-years-old female presented with persistent headache and vision loss and was found Covid 19 positive. Investigations suggested Covid 19 associated intracranial hypertension. She improved with medical management but again presented with acute vision loss. The visual loss was managed by endoscopic optic nerve fenestration surgery. She had significant recovery in vision during follow up period. Persistent headache in Covid 19 should have a high index of suspicion for idiopathic intracranial hypertension to avoid irreversible vision loss.

Peritonsillar abscess due to temporomandibular joint septic arthritis: an uncommon cause of a common disease.

Peritonsillar abscess is a common presentation of complicated acute tonsillitis. The temporomandibular joint septic arthritis is an uncommon clinical entity while its complications are further rare. We present a case of a man in his late 30s who presented with a painful swelling in the left preauricular region along with increasing trismus. A diagnosis of peritonsillar abscess due to septic arthritis was made based on clinical history and examination. Patient recovered fully after antibiotic and abscess drainage. This is the first case report of temporomandibular septic arthritis leading to peritonsillar abscess.

Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation.

BACKGROUND: Subannular tympanoplasty is a newer technique with limited research articles in the literature. These articles have limitation in terms of sample data. We reviewed outcome of subannular tympanoplasty performed during last five years in our center. OBJECTIVE: To determine the surgical and hearing outcome of circumferential subannular tympanoplasty. METHODS: A retrospective observational study was performed in a tertiary care academic center involving 224 subjects with mucosal chronic otitis media who underwent circumferential subannular type 1 tympanoplasty. RESULTS: Complete neo-tympanum was found in 213 cases (95.1%) at the end final follow period of 12 months after surgery. Eleven tympanic membranes did not take up the graft and considered failure at the end of 6 months after surgery. All of them were subjected for revision surgery and showed intact neo-tympanum after 12 months of surgery. The hearing outcome showed significant improvement in air conduction thresholds from 42.54 ± 13.04 dB to 30.48 ± 10.61 dB at the end of one year. No surgical complication was observed in the study group. CONCLUSION: The circumferential subannular tympanoplasty carries good surgical success and should be preferred in large and subtotal perforations. Randomized controlled trials are warranted to overcome the limitations in the present study. SIGNIFICANCE: This is the first study showing outcome of subannular tympanoplasty in large sample size of more than 200.

Synovial Sarcoma of Ethmoidal Sinus.

Background Synovial sarcoma is an aggressive soft tissue cancer of extremities mainly and rare in head and neck region, whereas rarest in ethmoidal sinus as only three cases have been reported till date. Case Reports We managed two cases of synovial sarcoma who presented with nasal obstruction, epistaxis, and swelling around the nasofacial region. Endoscopic nasal biopsy and immunohistochemistry markers confirmed synovial sarcoma in both the cases. While one case was managed by surgery and chemoradiation, the second patient received two cycles of ifosfamide-based chemotherapy and succumbed after 6 weeks of diagnosis. Conclusion Head and neck sarcomas are aggressive and carry a poor prognosis. Surgical resection with postoperative radiotherapy is the standard treatment. However, they have a high risk of recurrence and hence aggressive management and close follow-up is warranted for the optimal outcome.

Nasal Polyposis and Its Association with Cardiac Functions.

OBJECTIVE: The aim of the study was to ascertain the effect of nasal polyposis on cardiac functions. MATERIAL AND METHODS: A prospective randomized interventional open-label endpoint-controlled study was conducted in an academic tertiary care hospital. Thirty-one patients with chronic rhinosinusitis with nasal polyposis were enrolled and administered fluticasone furoate nasal spray for 3 weeks before randomly segregation into surgical or medical group. The treatment continued for 3 months in both groups. The SNOT-22 (Sino-Nasal Outcome Test-22) score, polyp grade, and right ventricular and pulmonary arterial functions were recorded in both groups before and after 3 months of the intervention. RESULTS: Both groups had significant improvement in SNOT-22 scores after 3 months of intervention. Both groups showed improvement in cardiac functions, but statistical significance was found only in subjects who underwent surgery. CONCLUSION: Nasal polyp affects cardiac functions, and this needs further evaluation and research through studies on large samples.

Effect of HIV and Antiretroviral Treatment on Auditory Functions

Abstract Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

Effect of HIV and Antiretroviral Treatment on Auditory Functions.

Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

Hürthle Cell Carcinoma in a Lingual Thyroid.

OBJECTIVE: To present a case of lingual thyroid Hürthle cell carcinoma (HCC). CLINICAL PRESENTATION AND INTERVENTION: A 37-year-old female presented with dysphagia and recurrent haemorrhage. Histopathology was suggestive of HCC; the tumour was excised by the trans-glossal approach which provided adequate exposure and helped avert external scarring or mandibular osteotomy. Histopathology showed a tumour-positive right lateral resection margin. This prompted referral to nuclear medicine for radio-iodine ablation. CONCLUSION: Lingual thyroid cases should be followed up closely and fine-needle aspiration biopsy should be considered when in doubt.

Deceptive nasal NK/T-cell lymphoma.

Nasal NK/T cell lymphoma is rare and it easily masquerades as chronic rhinosinusitis. It has a very poor prognosis and hence early diagnosis, although difficult, is necessary for better outcome. We present a case of a 30-year-old man who presented with nasal obstruction, facial oedema and crusts. High-resolution computed tomography found soft tissue in all sinuses and the nasal cavity. Endoscopic biopsy revealed necrotic and inflammatory tissue with fungi on culture. A diagnosis of fungal rhinosinusitis was made but the patient did not respond to antifungal drugs. A histopathology review with immunohistochemistry suggested nasal NK/T cell lymphoma. The patient was started on chemotherapy but died within 1 week.

Killian's polyp mimicking malignant tumor.

Killian polyp is predominantly found in children and any sinonasal tumor in elderly presenting with epistaxis and pain usually indicates malignant growth until proved otherwise. We present an unusual case of Killian polyp in an elderly patient that behaved as a malignant tumor. This case report reminded us that paranasal sinuses are still dark hollow mysterious cavities, and we should take utmost clinical acumen in managing such cases.

Hearing loss with phosphodiesterase-5 inhibitors: a prospective and objective analysis with tadalafil.

OBJECTIVES/HYPOTHESIS: To assess the effect of tadalafil on auditory functions. STUDY DESIGN: Prospective observational study in a tertiary care hospital. METHODS: Twenty-five tadalafil naïve patients with erectile dysfunction or pulmonary artery hypertension were subjected to pure-tone and brainstem-evoked response audiometry before drug therapy, and 3 and 30 days following drug therapy. Results were compared using analysis of variance for repeated measures with Bonferonni correction. RESULTS: Fifteen patients were taking tadalafil 10 mg for erectile dysfunction, and another 10 patients were on tadalafil 20 mg once daily for pulmonary artery hypertension. No statistically significant difference was found in hearing threshold at baseline and at follow-up (P > .05). However, three patients on tadalafil 20 mg showed a significant increase in hearing threshold at higher frequencies. There was no incidence of sudden sensorineural hearing loss in the study group. CONCLUSIONS: This is the first prospective and observational study that evaluated the effect of tadalafil on auditory functions with objective tests. Although there was no statistically significant result to confirm or refute the association between tadalafil and hearing impairment, increased threshold at higher frequencies after taking tadalafil supports the results from previous studies and hints at a possible relationship between the two. Similar large sample studies are warranted to know the exact association of phosphodiesterase-5 inhibitors on auditory functions.

Tonsillitis with acute myeloid leukemia: a case series for caution.

Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.

Calcifying (juvenile) aponeurotic fibroma of the scalp.

Calcifying aponeurotic fibroma is a benign tumor with a predilection for distal parts of the extremities; it is very rare in the head and neck region. It commonly affects young patients-hence the term juvenile in the name. It is fibroblastic in origin and considered a cartilage analogue of fibromatosis, but its exact etiology remains unknown. Clinically, this tumor needs to be differentiated from fibromatosis, nodular fasciitis, chondroma, schwannoma, and rheumatoid nodule. A 24-year-old woman presented with swelling in the forehead for the previous 6 months. Wide surgical excision of the lesion was performed, and histopathologic examination revealed a calcifying aponeurotic fibroma. We reviewed the literature on this rare clinical entity and present our hypothesis on its etiology.

Ectopic canine associated with a dentigerous cyst in the maxilla.

Ectopic eruption of a tooth is common in the dental arch, palate, and nose, but it is rare in the maxillary antrum. We present the case of a 35-year-old man with an ectopic canine and an associated dentigerous cyst in the maxillary sinus that masqueraded as an antrochoanal polyp.