Cervical thymic cyst ? A Rare Neck Swelling in an Adolescent.

Cystic neck masses in adolescents pose a diagnostic challenge as they be neoplastic or non-neoplastic, congenital, inflammatory, or infectious. Detailed history and examination, anatomical location of the lesion may help narrow down the differential diagnosis of such masses. Cervical thymic cysts contribute to less than 1% cystic lesions in the neck. We present one such case and our management strategy.

Interventional Study of Flunarizine Therapy on Symptom Relief and Vestibular Evoked Myogenic Potential Changes in Individuals with Vestibular Migraine.

INTRODUCTION: Migraine is the third most common disease in the world with an estimated prevalence of 14.7%. The purpose of this study was to identify the characteristic changes in cervical and ocular vestibular evoked myogenic potential (VEMP) and analyse changes in symptoms and VEMP after flunarizine therapy in patients diagnosed with vestibular migraine (VM). METHODS: Prospective interventional study was conducted on 31 VM patients. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were recorded. Flunarizine (10 mg) was given once daily for two consecutive months. Prophylactic therapy was monitored with a monthly follow-up assessment of their symptoms and VEMP was repeated after 2 months. RESULTS: Headache was the chief complaint (67.7%). Vertigo was spontaneous and mostly moderate in intensity (93%). cVEMP was absent in 1 patient and oVEMP was absent in 3 patients. Post prophylactic treatment with flunarizine, there was significant reduction in the frequency (p = 0.001) and duration (p = 0.001) of headache and frequency (p = 0.001), duration (p = 0.001), and intensity (p = 0.009) of vertigo. cVEMP and oVEMP showed no significant differences (p > 0.05) between pre- and post-treatment recordings. CONCLUSION: Treatment with flunarizine helps in considerably reducing the episodes and duration of headache, as well as episodes, duration, and intensity of vertigo.

Unusual cause of unilateral facial oedema: intramuscular dirofilariasis.

INTRODUCTION: Unilateral facial oedema may occur due to inflammatory, infective, or cystic pathology; patients often seek medical help at an early stage. CASE REPORT: We report one such case caused mimicking a parotid abscess, caused by dirofilariasis. CONCLUSION: Dirofilariasis is an emerging zoonosis and should be considered a differential diagnosis of atypical facial swelling. It is equally important for clinicians, radiologists, and pathologists to be familiar with the diagnostic characteristics to avoid misdiagnosis.

Evaluation of outcome of acoustic reflex tests in patients with type 2 diabetes mellitus: a cross-sectional study.

PURPOSE: Type 2 diabetes mellitus (T2DM) may induce micro-vascular and macro-vascular changes that can lead to neuropathic changes which may affect the auditory pathway resulting in hearing loss. The study aims to evaluate the outcome of ipsilateral and contralateral acoustic reflex (AR) parameters and reflex decay tests (RDT) in patients with T2DM, and the relationship between average AR parameters, and duration and control of T2DM. METHODS: An analytical cross-sectional study was conducted in a tertiary care setup in 126 subjects which included 42 subjects with T2DM between 30 and 60 years of age, age-matched with 84 non-diabetic subjects. The subjects were evaluated for pure tone average (PTA), speech identification score (SIS), AR parameters [acoustic reflex threshold (ART), acoustic reflex amplitude (ARA), acoustic reflex latency (ARL)] and RDT. RESULTS: The subjects with T2DM showed increased PTA in both ears when compared to the subjects with no disease. No significant difference was found in the SIS between both groups. There was no significant difference in the ART and ARL between the two groups. There was a significant difference in the ipsilateral and contralateral ARA at 500 Hz, 1000 Hz and broadband noise (BBN) when compared between the diabetic and non-diabetic groups. No significant difference was found between average AR parameters and duration and control of T2DM. CONCLUSION: T2DM increases hearing thresholds and reduces ipsilateral and contralateral AR at lower frequencies and BBN. Duration and control of T2DM do not affect the AR parameters.

Modified-modified radical mastoidectomy.

PURPOSE: It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case. CASE PRESENTATION: A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy. CONCLUSIONS: Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.

A Silent Non-thyroidal Adenoma in the Thyroid.

The surgeon needs to assess clinically significant thyroid nodules as they may represent aggressive forms of thyroid cancer or ectopic parathyroid glands. We discuss one such unusual nodule in the thyroid.

Bone Changes in Chronic Rhinosinusitis: Pathological or Physiological?

Bone remodelling is a normal physiological process which occurs in all bones. Hence bone changes should also be detected in undiseased or minimally diseased ethmoids as well as in chronic rhinosinusitis (CRS) patients. To test this hypothesis, we compared ethmoid bone histology between two groups of patients; a study group of CRS patients and a group of patients whose radiological, endoscopic and symptom scores were significantly less when compared to the CRS group. The study group had 75 patients who underwent functional endoscopic sinus surgery for CRS. The control group included 16 patients who had significantly different endoscopic and radiological scores from the study group. On histopathology, the bone harvested from the ethmoid sinuses were grouped as no remodelling activity (Score 1), mild activity (Score 2) and marked activity (Score 3). Thirty-six percent of patients in the study group and 37.5% of patients in the control group had Score 2 and 3 bone changes and the difference was not statistically significant (χ2 = 1.824, p = 0.402). Correlation of bone changes in CRS done with parameters like Lund-Mackay radiological, surgical and symptom scores and Lund-Kennedy endoscopic scores showed no statistical significance. Similar bone changes were detected in CRS patients and the control group. The bone changes seen in histopathology in CRS patients could partly be due to the normal physiological remodelling occurring in all bones.

Quality of life and perceived financial implications among otorhinolaryngologists during the COVID-19 pandemic across India.

OBJECTIVE: The changing trends in medical practice, uncertainties and monetary apprehensions due to the COVID-19 pandemic may influence the sense of well-being among otorhinolaryngologists. The present study was conducted to evaluate quality of life (QOL) and perceived financial implications in otorhinolaryngologists during the COVID-19 pandemic across India. METHODS: A cross-sectional study was carried out among otorhinolaryngology specialists across India using WHOQOL-BREF and Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale questionnaires on Google Forms, which was kept open for the latter half of July 2020. RESULTS: A total of 358 responses were obtained; the response rate was 26.64%. Twenty-four percent of respondents worked exclusively in academic settings; 40.22% of specialists had over 10 years of work experience. Average monthly income in 2019 was between 1-3 lakhs Indian Rupees (INR) in 43.85%, while in 2020, 62.57% of the specialists had an average monthly income of below one lakh INR; this difference was statistically significant (p < 0.001). Mean WHOQOL-BREF scores for physical, psychological, social and environmental domains were 68.8 ± 1, 62.3 ± 0.75, 68.9 ± 1.17 and 65.8 ± 1.01, respectively; mean CFPB financial well-being scale score was 55.5 ± 0.66. QOL and financial well-being were better in otolaryngologists older than 60 years, male specialists and private consultants. CONCLUSIONS: There has been a tremendous impact on quality of life and financial well-being among otorhinolaryngologists in India during the COVID-19 pandemic. The study outcome may help otolaryngologists comprehend and perceive the extent to which it has affected their professional and personal lives, and explore ways to face and overcome the situation.

Depression profile in malignancy patients attending otorhinolaryngology clinic.

PURPOSE: Patients with malignancy quite often suffer from physical as well as psychological symptoms due to the shattering diagnosis, and prolonged, incapacitating management. The frequency of the depressive disorder in malignancy is around 8-40%. The present study aims at analysing the socio-demographic profile and magnitude of depressive disorders in patients with malignancy. METHODS: A cross-sectional study was conducted in malignancy patients attending an Ear Nose Throat department using the PHQ-9 questionnaire. RESULTS: Total PHQ-9 score ranged from 0 to 19; the mean score was 8.46. Major depressive disorder was seen in 4 (8%) cases, while other depressive disorder occurred in 22 (44%) cases. Mild severity of symptoms was noted in 15 (30%) of the patients. High statistical significance was noted between PHQ-9 score for MDD and other depressive disorder (p value < 0.001). CONCLUSION: The profile of depressive disorders in malignancy varies; PHQ-9 can be used as a good tool for early detection.

Lymphoepithelial Cyst of Parotid in an Immunocompetent Patient with Chronic Otitis Media.

Lymphoepithelial cysts of parotid are known to occur in HIV patients. In the present report, lymphoepithelial cyst of parotid was diagnosed in a middle aged immunocompetent patient, along with chronic otitis media. The source of infection and treatment options are summarized.

Anaerobic Bacteriological Microbiota in Surface and Core of Tonsils in Chronic Tonsillitis.

INTRODUCTION: Tonsillar infection may stem from bacteria within tonsillar crypts or parenchyma rather than from those on the surface. Pathogens isolated from surface culture may be colonizing the tonsil, but not essentially infecting it. Anaerobes though not often studied, are known to cause chronic tonsillitis. AIM: To study the correlation of anaerobic bacterial isolates in surface and core cultures from recurrently infected and inflamed tonsils. MATERIALS AND METHODS: A cross-sectional study was conducted in Charitable Hospital and Medical Research Centre, Belagavi from January 2014 to December 2014 on 100 patients of chronic tonsillitis who underwent tonsillectomy. Swabs were obtained from tonsil surface and core and analysed for anaerobes as per standard protocol. Chi-square test and Fischer-Exact test were used for statistical analysis. RESULTS: Twenty eight out of 63 (44.4%) patients had anaerobic growth on tonsil surface and 30 out of 62 (48.4%) patients had anaerobic growth in tonsil core. Porphyromonas sp. was the most common anaerobe isolated from the surface as well as from the core. There was no statistical significance between anaerobes isolated in the tonsil surface and core. CONCLUSION: Anaerobic organisms obtained from tonsil surface and core cultures were similar. A throat swab satisfactorily depicts the core organism and is reliable in recognizing the bacteriology of chronic tonsillitis. Anaerobic organisms known to inhabit the surface as well as the core of tonsils may be treated with suitable antibiotic therapy.