A Rare Case of Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) of Vocal Cord.

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumour named after Pierre Masson is a benign lesion of vascular origin which is characterized by reactive proliferation of endothelial cells with papillary formation. It is an extremely rare entity which can present anywhere in the body but is particularly found in the extremities and head and neck regions most commonly the lips, oral mucosa, tongue, gingiva, or buccal mucosa and due to its close resemblance to Angiosarcoma, it becomes important to distinguish between these two entities to avoid unnecessary aggressive treatment. CASE REPORT: Here, we describe a case of 23-year-old male who presented with change in voice since 8 months. Preoperatively, laryngoscopic examination showed right vocal cord polyp in the anterior one-third of the cord with hemorrhagic changes. He underwent micro-laryngeal surgery using suspension laryngoscope and the lesion was excised completely. Histopathological report was consistent with IPEH. CONCLUSION: Herein, we describe a rare benign case of IPEH arising from the vocal cord and we provide a brief review of relevant literature and a detailed report of this rare entity.

To Determine the Efficacy of Pentoxifylline in the Management of Bell's Palsy.

Background and aims: Bell's palsy is an acute, unilateral, lower motor neuron peripheral facial paralysis. It is the most common cause of facial paralysis in the ages ranging from 13 to 65 years. It not only causes physical disfigurement of face but is also associated with social stigma and psychological trauma to the patient. In Bell's Palsy, there is hypoxic damage to the nerve due to reduced blood flow and cellular injury to the capillaries. Pentoxifylline is a phosphodiesterase inhibitor that increases the cAMP and cGMP levels at the site of the RBC cell membrane thereby improving the dexterity of the cell membrane allowing the RBCs to pass through the damaged and narrowed blood vessels thereby improving the perfusion and oxygen delivery to the damaged tissues. Vasoactive agents are not routinely used as an active component in the treatment. Since vascular compromise plays a predominant role in the pathophysiology of Bell's palsy, it is proposed that the addition of a vasoactive agent like Pentoxifylline can improve the recovery rate and shorten the duration of treatment in the management of Bell's Palsy. Materials and methods: The study was conducted in the Department of ENT, BMCRI, Bangalore during the period February 2021 to August 2022. This is a prospective randomized control study which included 70 patients attending the out-patient department of ENT, Bangalore Medical College and Research Institute, Bangalore. Written informed consent was taken from all patients included in the study. A detailed history, thorough clinical examination, and relevant investigations were done for these patients. Patients were randomly divided into Group A and Group B based on random numbers generated by the WINPEPI software version 11.65. The study group (Group A) received standard treatment in addition to Tab Pentoxifylline 400 mg TID for 1 week. The control group (Group B) received only the standard treatment regimen. Patients were followed up on Days 5, 10, 15, and 6 months to assess recovery following treatment. The recovery of facial nerve function was evaluated as per the House-Brackmann Grading system for any improvement. Both pre-treatment and post-treatment HB grades were analyzed. The data collected were tabulated and subjected to statistical analysis using ANOVA. Results: The age distribution of the patients showed that the most common age group affected in this study was 18-30 years. Males were affected more than females (1.2:1). The most common HB grade at presentation noted in this study was Grade 4 in both groups (54.2%). At the beginning of the treatment, in Group A, around 43% patients had HB grade of 3 and 57% patients had HB grade of 4. In Group B, around 20% patients had HB grade 2, 28.57% patients with grade 3 and 51.43% patients with grade 4. After a follow-up period of 6 months, in Group A, around 43% of patients achieved a HB grade of 1, 51% patients achieved a grade of 2 and about 6% patients had a grade of 3. In Group B after a follow up period of 6 months, 29% patients achieved HB grade of 1, 46% patients achieved grade of 2 and 26% patients had a grade of 3. It was observed that 42.86% of patients had better outcomes (Normal facial function) in Group A (Study group) compared to 28.57% of patients in Group B (Control group). It is evident that a patient who presented with HB grades of 2 or 3 and who presented within 5 days had better chances of recovery which was statistically significant (p = 0.001). Interpretation and conclusion: From the present study, it may be concluded that Bell's palsy occurs in all age groups. It affects younger age groups more commonly (2nd decade) and affects males more than females. The study group who had received Tab Pentoxifylline along with standard treatment had better outcome. This highlights the benefit of vasoactive agent in the management of Bell's palsy by improving the oxygen delivery to the affected tissues. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04298-9.

Our Experience of Surgically Managing Orbital Complications Due to Chronic Sinusitis: A Case Series.

Despite antibiotic treatment applied in Otorhinolaryngology, orbital complications due to chronic rhinosinusitis are considered a threat to the functions of the eyes. If timely intervention is not provided, orbital complications could rapidly progress to optic neuritis or life-threatening intracranial complications. A retrospective study included four patients between the ages of 29-70 years with orbital complications due to chronic sinusitis. Diagnosis was based on history, clinical examination, and imaging. In all cases, treatment was initiated with intravenous antibiotics and steroids. Surgical intervention was performed in all the patients when symptoms failed to resolve after 48 h of intravenous treatment. In our study, we encountered patients with orbital complications which included pre-septal cellulitis (75%) and frontal sinus fistula (25%). Average time of hospital stay was 9.5 days. All patients underwent surgery after 48 h of intravenous treatment and showed resolution of orbital symptoms within 2-6 months post-operatively. No recurrences have been encountered till date. Orbital complications are severe pathologies which require immediate attention and aggressive treatment via endoscopic approach as well as antimicrobial treatment to prevent unwanted threat to life.

A Study on the Outcome of Myringoplasty in Small to Medium Sized Perforations Using Collagen Sheet as Graft Material.

Chronic Otitis Media is a global health problem causing significant morbidity of life. Various medical and surgical treatment modalities are being used for the treatment of Chronic Otitis Media. Surgical treatment is the definitive option which includes different surgical procedures, all of which have been designed to attain the same goals of eradicating disease and achieve a safe and dry ear with closure of tympanic membrane perforations. Various graft materials are being used for the closure of tympanic membrane perforations like autografts, isografts, allografts and xenografts, each having its own advantages and limitations. The trend towards increasingly less invasive medical procedures, with shorter hospitalisation stay has led to demand for materials to replace autologous grafts, one such material being the collagen. The purpose of this study is to evaluate the outcome of myringoplasty in small to medium sized perforations using collagen sheet as the graft material. In the period from November 2018 to May 2020, 50 patients after fulfilling the inclusion and exclusion criteria were taken up for myringoplasty. They underwent myringoplasty using transcanal approach and collagen sheet was used to close the tympanic membrane perforation. Post-operatively, patients were treated with antibiotics and regularly followed up. Otoendoscopy was done at the end of 1st month and 3rd month. At the end of 3 months, patients were evaluated for graft uptake and pure tone audiometry repeated to evaluate the post-operative hearing gain. In this study, we examined a total of 50 patients with 25 males and 25 females (50%). The mean age of our patients was 29.42 years, ranging from 18 to 60 years; with almost 66% between 21 and 40 years. Treatment was considered successful if there was complete closure of tympanic membrane perforations. Of the 50 patients that were included; graft uptake was noted in 46 patients i.e. in 92%, closure was achieved at the end of 3 months. Four failures in our study were due to infections. In this study, the graft uptake following myringoplasty was analyzed with statistically significant objective parameters like age, gender, size of perforation, laterality of disease, etiology of CSOM that affect the success of tympanoplasty. It was observed that small sized perforations had more chances of graft uptake. Post-operative hearing outcomes were also evaluated and was found to be statistically significant. Collagen sheet provided promising results as a graft material for myringoplasty and the graft uptake rates were comparable to the success rates of other conventional autologous grafts. Post operatively, significant improvement in hearing was also noted.

A Rare Case of Tubercular Osteomyelitis of Maxilla: A Case Report.

Tuberculosis (TB) is a chronic granulomatous infection which primarily affects lungs. It is caused by Mycobacterium tuberculosis which was discovered by Dr Robert Koch. It can also affect other organs. Tuberculosis is a major cause of morbidity and mortality in developing countries. Early detection and initiation of antitubercular therapy are important in the management of TB. Extrapulmonary TB might not exhibit same features as pulmonary tuberculosis. Tuberculosis of maxilla is an extremely rare entity which can be misdiagnosed as carcinoma of maxillary sinus or other infectious conditions. We are presenting a case of tuberculous osteomyelitis of maxilla in a 14-year-old female who came with a discharging sinus over the right cheek. She underwent endoscopic debridement of sinuses and histopathological examination was suggestive of Koch's infection. Patient was further treated with antitubercular therapy and showed significant improvement at four weeks follow up.

Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine.

ABSTRACT: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. This study was conducted in our institute on 90 patients who presented to the outpatient department with history of vertigo and were diagnosed with BPPV via a positive Dix Hallpike test. Patients were randomnly placed in three groups of 30 each. Patients in Group A were treated with Epleys manoeuvre alone, in Group B were treated with Epleys Manouvre followed by oral Betahistine and patients in Group C were treated with Betahistine alone. All the patients were followed up after 1 week and 4 weeks following treatment. In our study we found that patients responded better when they were treated with Epleys Manouvre with Betahistine with less relapse and recurrence. Treatment with Epleys manouvre resulted in early improvement of symptoms. It was found in our study that Betahistine as a sole modality of treatment of vertigo in BPPV can be preferred in patients who are unfit to undergo canal repositioning manouvres.