Indian Journal of Otolaryngology and Head & Neck Surgery

Published by Springer Verlag
Online ISSN: 0973-7707
Relationship between immunohistochemical parameters and patients with inverted papilloma 
Diffuse and high positivity for p63 in squamous cell carcinoma (Peroxidase stain; orginal magnification 9220)
Squamous cell carcinoma with nuclear positivity for p53 protein in most of its cells (Peroxidase stain; original magnification 9220)
Relationship between immunohistochemical parameters and patients with squamous cell carcinoma
Expression of p53 in inverted papilloma and squamous cell carcinoma 
Using a molecular genetic approach, we try to confirm the molecular alterations of inverted papilloma and clarify its status as a putative precursor lesion of sinonasal squamous cell carcinoma. To better understand its genetics, we investigated the immunohistochemical protein expression patterns of cell-cycle-regulators p53, p63, p21, p27 and proliferation marker Ki-67 in 22 inverted papilloma and 9 squamous cell carcinoma of the sinonasal tract. Significantly elevated levels of p53 and p63 in squamous cell carcinoma of sinonasal tract compared with inverted papilloma were revealed. Ki-67-stained neoplastic cell nuclei were found in a significantly higher percentage of squamous cell carcinoma of sinonasal tract than in inverted papilloma, whereas no variation of p21 and p27 expression was identified. This work first examined the immunohistochemical overexpression of p63 in sinonasal inverted papilloma and squamous cell carcinoma. In conclusion, this is a first study shedding light on the expression of p63 in tumors of paranasal sinuses.
Standard treatment of mandibular angle fracture with miniplates according to recommendations of Champy et al. (1976) consists of fixation with one miniplate at superior border of mandible ventral to external oblique line. In certain constellations, second miniplate at lower border may provide additional stability. In this retrospective study 80 patients with mandibular angle fracture were divided into 3 sub-groups reported at DIRDS Faridkot were treated by intraoral, extraoral and combined intraoral and transbuccal approach. There was no significant difference in complication rates encountered with these techniques. Decision regarding treatment approaches for open reduction of mandible fracture often relates to surgeon's experience and training. In some cases, choice is affected by availability of equipment. More difficult cases involving endentulous atrophic mandible or comminution should be considered for extraoral approach. Intraoral open reduction and fixation was used for non-comminuted and non-complicated fractures. The combined transbuccal/Intraoral procedure is now preferred method because of ease of use and facilitation of placement of plate in neutral mid point area of mandible.
Postaural incision with sinus tract extending anteriorly  
Sinus tract extending to preauricular sinus  
Preauricular sinus (PAS) is a common congenital anomaly which is usually asymptomatic and noted on routine otolaryngological examination which requires no treatment. Patients presenting with discharge, recurrent infections and preauricular abscess will require management with antibiotics and surgical extirpation of the sinus tract. We present a rare case of a PAS presenting as a recurrent postaural abscess.
A case of epiglottic abscess in an otherwise healthy adult male is reported. Patient was initially managed as acute epiglottis with parenteral antibiotics, humidified air, and steroids close ICU monitoring. Failure of recovery and re-evaluation revealed an abscess of epiglottis. Management with intubation and incision and drainage of abscess lead to very rapid recovery and subsequent discharge of patient.
26 Days after 1st drainage with fully resolved abscess shown in Fig. 5 
The existence of complications of suppurative otitis media and efforts to control it go far back into history. Early diagnosis and management have been greatly modified by the extensive use of CT scan and higher antibiotics. Despite an overall decline in the incidence of complications of otitis media, severe complications still exist with high mortality. Suggested reasons are decrease in physician's experience and changing of the virulence and susceptibility of causative organism. This series is a prospective study of 18 cases of otogenic brain abscess, carried out in Department of ENT and Head & Neck Surgery, SSG Hospital, Baroda from June 2005 to June 2008. We emphasize on confirmation of resolution of brain abscess by CT scan. This will eliminate recurrent/residual abscess and help in reduced overall mortality and morbidity.
Status Of LPO, SOD and CAT in mucosa before and after treatment with antioxidants 
Status of LPO, SOD and CAT in serum before and after treatment with antioxidants 
Contents of the anti-oxidant capsule 
Final Result (by Carter's criteria) 
Antioxidants are widely used in chemoprevention of malignancy. Numerous studies in medical literature have reported the evaluation of this treatment protocol by indirect methodology-epidemiology, invitro studies, pharmacology and animal models etc. However, there is a paucity of literature on the measurement of antioxidant enzymes as a parameter for assessing the outcome of antioxidant therapy. This study explores the efficacy and outcome of antioxidant enzyme assay in relation to antioxidant therapy in tobacco abusers, hitherto unreported in medical literature. A prospective cohort study with control in 50 patients carried out at a tertiary care teaching Institution (Institute of Medical Sciences, Banaras Hindu University, Varanasi, India). Out of these patients, 10 patients acted as control, rest 40 patients-all tobacco users in some form, were divided into three groups on the basis of histopathological grading of dysplasia-no dysplasia, mild or moderate dysplasia. The levels of Lipid peroxidase (LPO), Superoxide dismutase (SOD) and Catalase (CAT) in mucosa and serum were assayed in each group, and re-evaluated at the end of 3 months after intervention with antioxidant treatment. To detect any alteration in degree of dysplasia a repeat biopsy was also done at the end of 3 months. The results were statistically analysed using paired t test. A statistically significant decrease in level of LPO and SOD, and an increase in CAT levels were recorded both in mucosa and serum. However, no change in dysplasia and no new case of dysplasia were observed. Further, antioxidant treatment was continued for a year and the final out come of the lesion was assessed by "Carter's criteria". A final success rate of 74.19% was recorded in terms of partial or complete regression of the lesion. This study confirms the therapeutic efficacy of antioxidants in oral leukoplakia, and cites the importance of LPO, SOD and CAT in evaluating the efficacy of antioxidant treatment. However, the study failed to elucidate any relationship between enzyme measurement and the final outcome of the lesion.
Other problems related to sleep difficulties 
Apnea index score distribution 
Sleep problems and their direct consequence, sleepiness, results in critical effects on psychomotor skills, memory, decision making, concentration and learning; all of which may play roles in accidents and errors. Despite the importance of quality of sleep among drivers there are only few researches that deal with them. Therefore, we designed this research to better understand possible relationships. This cross-sectional study was performed between 2006 and 2007 among 175 bus drivers of a transportation company in Tehran, the capital of Iran. Participants filled out a questionnaire concerning their demographic and personal history, associated disease, the insomnia index, the Epworth sleepiness scale (ESS), and the apnea index. Then they elaborated their history of crashes. Data was analyzed with the SPSS software through χ(2), Oneway ANOVAs, and Pearson correlation tests. The mean age, and body mass index (BMI) were 43.47 ± 6.85 years and 26.35 ± 3.87 kg/m(2). The mean duration of sleep among these drivers was 6.37 ± 1.62 h per day. The mean accident rate was 2.31 ± 1.83 per year. There was a significant correlation between the insomnia index and BMI (P = 0.014), age (0.00), marital status (0.00), associated disease (0.005), and drug history (0.028). There was a significant relationship between marital status and the ESS, and also between age and accident rate in the past years. Sleep problems were a frequent finding among the studied group and had a significant relationship with their crash history. These results can be an alarming sign to choose bus drivers more carefully and pay more attention to treating their sleep disorders.
Frequency of reference errors in IJOHNS
This study was done to observe the accuracy of references in articles published in Indian Journal of Otolaryngology and Head & Neck Surgery. There were 63 references randomly selected from different issues of Indian Journal of Otolaryngology and Head & Neck Surgery (IJOHNS). It includes: Volume 61, Number 4, December 2009 and Volume 62, Number 1, January 2010. References were examined in details by dividing them into six elements and they were compared with the original for accuracy. References not cited from indexed journals were excluded. Statistical analysis was done by using frequency and percentage. Results show that 30.1% references in Indian Journal of Otolaryngology and Head & Neck Surgery were incorrect. Most common errors were author's name and journal name. Author's names were found to be incorrect in 11.1% references while journal name were found to be incorrect in 6.3%. Errors in citing the references are also found in the Indian Journal of Otolaryngology and Head & Neck Surgery. The quoted error in this study is comparable to other international literatures. The majority of errors are avoidable. So, the authors, editors and the reviewers have to check for any errors seriously before publication in the journal.
Amplitude modulation spectrogram for word (top left clear, top right conv) and for word (bottom left clear and right conv) 
Mean, standard deviation, significance of mean difference in duration between clear and conversational speech
The overall goal of this study is to examine the intelligibility differences of clear and conversational speech and also to objectively analyze the acoustic properties contributing to these differences. Seventeen post-lingual stable sensory-neural hearing impaired listeners with an age range of 17-40 years were recruited for the study. Forty Telugu sentences spoken by a female Telugu speaker in both clear and conversational speech styles were used as stimuli for the subjects. Results revealed that mean scores of clear speech were higher (mean = 84.5) when compared to conversational speech (mean = 61.4) with an advantage of 23.1% points. Acoustic properties revealed greater fundamental frequency (f0) and intensity, longer duration, higher consonant-vowel ratio (CVR) and greater temporal energy in clear speech.
A 73-year-old man was transferred after cardiopulmonary resuscitation with endotracheal intubation. The neck computed tomography revealed about a 6.5 × 5 cm homogeneous, mildly enhancing cystic mass in the thyroid isthmus, occupying nearly the entire lower central neck region and compressing the trachea. An emergency subtotal thyroidectomy was performed.
Showing age distribution (n = 82)
showing the total number of visits till complete subsidence of edema (n = 82)
To compare the efficacy of treatment between steroid-antibiotic and 10% Ichthammol glycerine packs (IG packs) in acute otitis externa. A prospective, randomized clinical trial between steroid-antibiotic and 10% IG pack which was performed in department of ENT-HNS, Kathmandu University Hospital, Dhulikhel from July 2009 to December 2009 on 82 patients. Pain was assessed by Numerical Rating Scale (NRS) and edema was assessed by dividing the external auditory canal in four quadrant giving score of 25% for each on the day of presentation and subsequent visits till tragal tenderness and edema subsided. Age group among studied patients ranged from 10 to 60 years, with mean of 23.5 years. Out of which 42 (51.2%) were females and 40 (48.8%) were males. Average number of visits in 10% IG pack group (n = 41) was 5.4 days (2-5 visits) while in steroid-antibiotic group (n = 41) it was 3.5 days (2-5 visits). There was statistically significant decrease in the number of visits in steroid group (P < 0.05). Similarly, decrease in pain score in second visit was statistically significant (P = 0.02) in steroid-antibiotic group as compared to 10% IG pack, while the edema score in second visit while comparing steroid-antibiotic group with 10% IG pack was statistically not significant (P = 0.07), whereas it was statistically highly significant on fourth visit (P = 0.001). Since the control of pain and edema is more and hence the number of visits is significantly less in steroid-antibiotic packing group, so it is worthwhile to use steroid-antibiotic pack for effective treatment of acute otitis externa.
Comparison of visual analogue scale scoring in patients of acute rhinosinusitis amonth the same group on day 1, 7/12 or day 35/40 as well as intergroup comparison on day 7/12 or day 35/40
Comparison of Axelssons radiographic scoring by sinus X-rays in patients of acute rhinosinusitis among same groups on day 1 with day 7/12 or day 35/40 as well as intergroup comparison on day 7/12 or day 35/40
X-ray maxillary sinuswaters view (Group 1)  
X-ray maxillary sinuswaters view (Group 2)  
X-ray maxillary sinuswaters view (Group 3)  
To compare the efficacy of gatifloxacin, azithromycin with amoxicillin as positive control for the treatment of Acute rhinosinusitis (ARS). To monitor adverse drug reaction profile of amoxicillin, azithromycin and gatifloxacin in patient of ARS. An open randomized trial of comparative efficacy and safety of amoxicillin, azithromycin and gatifloxacin in patients with ARS. Patients were randomized into three groups as under: group 1: patients on oral amoxicillin 500 mg TDS for 10 days; group 2: patients on oral azithromycin 500 mg OD for 5 days; group 3: patients on oral gatifloxacin 400 mg OD for 10 days. Patients were evaluated for signs and symptoms at day 1, day 7 (for group 2), on day 12 (for group 1, 3) as primary end points and 28 days after post therapy as secondary end point. All the three antimicrobial drugs i.e., amoxicillin, azithromycin and gatifloxacin were effective in reducing symptoms of acute sinusitis on visual analogue scale scoring. Azithromycin showed significant improvement radiographically on day 7 (P < 0.01) and on day 35 (P < 0.01). Gatifloxacin elicited very highly significant improvement radiographically on day 40 (P < 0.001) and significant improvement on day 12 (P < 0.01) when compared with amoxicillin. Azithromycin, the ketolide was associated with lesser adverse effects as compared to amoxicillin. All the three antimicrobial drugs i.e., amoxicillin, azithromycin and gatifloxacin were effective in reducing symptoms of acute sinusitis on visual analogue scale scoring. Gatifloxacin was found to be most effective drug both in terms of improvement in signs and symptoms on visual analogue scale and radiographic scoring and was associated with least adverse events in comparison to rest of two drugs under study.
Scoring system for airway inflammation 
This study aimed to investigate the association of inflammatory changes of upper and lower airways in a rabbit model of acute rhinosinusitis. The study included six adult albino rabbits. The sinuses of one animal were injected with saline solution and the animal was served as sham control. Other animals were implanted with intranasal S. aureus soaked-absorbable gelatin sponge. Acute rhinosinusitis was induced and subjects were sacrificed at the end of the second week. Tissue samples from all levels of the airway were obtained. They were evaluated for the presence of inflammatory changes histologically. A scoring system for airway inflammation was used for quantitative assessment of the degree of inflammation. Structural changes in the epithelial and stromal layers of the upper and lower airway structures were analyzed, as well. The animal of which the sinuses were injected with saline solution developed neither acute rhinosinusitis nor lower airway inflammation. In contrast, the animals in which acute rhinosinusitis was induced demonstrated significant upper and lower airway inflammation histologically. Inflammatory changes ranged from engorgement of blood vessels and polymorphonuclear cell proliferation within the capillaries, in the perivascular tissue of the epithelium or in the lamina propria and to epithelial disruption. Nasal airway inflammation scores (2.86 ± 1.81) were significantly higher than lower airway scores (1.36 ± 0.77), (P < 0.01). We obtained a generalized mucosal inflammatory response against localized bacterial inflammation in a rabbit model of acute rhinosinusitis, confirming the suggestion of 'one airway--one disease' from a bacterial infection point of view.
The distribution of the patient's ages  
The percentage of aerobic microorganisms isolated from tonsil and adenoid tissue
microorganisms isolated from tonsil and adenoid tissue along with the number and percentage of beta-lactamase producing bacteria
Adenoidectomy and tonsillectomy, indicated for children with recurrent or persistent symptoms of infection or hypertrophy, are among the most frequent operations performed in children. This study was carried out for investigating the microbial flora of the tonsils and adenoids regarding to core and surface microorganisms and also pathogen microrganisms' beta-lactamase production rate. Cultures were taken from the core and surface of tonsils and adenoids of the 91 patients at the time of the surgery for tonsillectomy and adenoidectomy. Aerobic and anaerobic cultures were inoculated and identified. Beta-lactamase production was detected also. The most frequently isolated aerobic microorganisms were Streptococcus viridans and Neisseria spp. The number of the microorganisms isolated from the tonsil core compared to the surface of the tonsils was found statistically insignificant (P > 0.05). The number of the adenoid surface aerobic microorganisms was found higher from the adenoid core (P < 0.05). The amount of adenoid and tonsil core anaerobic microorganisms were alike. The patients' preoperative antibiotherapy whether using beta-lactam or beta-lactamase resistant were compared for beta-lactamase producing bacteria production and the number of beta-lactamase producing bacteria were found statistically insignificant (P > 0.05). The togetherness of Staphylococcus aureus and other beta-lactamase producing bacteria was found statistically significant (P < 0.05). This study demonstrates that there is polymicrobial aerobic-anaerobic flora in both adenoids and tonsils. There was a close relationship between the bacteriology of the tonsil and adenoid flora. Staphylococcus aureus and and other beta-lactamase producing bacteria may be responsible for treatment failures in patients with tonsillitis.
Symptomatology of obstructive adenoid 
To evaluate the relevance of routine electrocardiographic request in pre-operative work-up of children undergoing adenoidectomy. This is a two year prospective study of children with obstructive adenoid that had adenoidectomy. This is a tertiary hospital based study at the Otorhinolaryngology Department of University College Hospital, Ibadan. Children (≤12 years) with clinical and radiological evidence of an obstructive adenoid were investigated. Information obtained with an interviewer assisted questionnaire included the biodata, clinical presentation of the patients, ECG findings, echocardiographic findings, cardiothoracic ratio, palatal airway and ratio of adenoid diameter to the nasopharyngeal diameter. The adenoid volume was measured after adenoidectomy. The results were analyzed using SPSS version 14 and level of statistical significance was P < 0.05. There were seventy four patients; 45 (60.8%) males and 29 (39.2%) females with a mean age of 38.35 months, S.D ± 30.32 (range 5-144 months). All the patients presented with mouth breathing and recurrent mucopurulent rhinorrhea. Mild snoring was detected in 18 (25%) patients, moderate snoring in 39 (54.17%) patients and severe snoring in 15 (20.83%) patients. Mild apnea was observed in 55 (74.32%) patients and moderate in 19 (25.68%) patients. Only seven (9.46%) patients had abnormal electrocardiographic findings but their ejection fraction on echocardiography ranged from 63 to 72% with a mean value of 68.17%, S.D ± 3.22. Cardiac complications of enlarged obstructive adenoid appear not to be common. Routine preoperative electrocardiography should therefore be restricted to only the high risk patients.
Monopolar suction diathermy allows controlled resection of the adenoids in a near bloodless field. In this article the author describes some technical points to make the procedure safe.
To describe endoscopic power assisted adenoidectomy and review the experience with the procedure demonstrating its safety and efficacy. Prospective study of 44 patients aged between 7 to 15 years undergoing power assisted adenoidectomy between Jan 2004 and July 2006. Tertiary care private teaching hospital. Forty four consecutive children with adenoid hypertrophy undergoing power assisted adenoidectomy. Therapeutic endoscopic adenoidectomy using microdebrider. Operative time, blood loss, complications, completeness and depth of removal, surgeon's satisfaction and recovery period. The average operative time was 12 min (range: 8-16 min) and average blood loss was 30 ml (range: 24-42 ml). Complete resection was possible under vision with few complications. The surgeon satisfaction was high and post-operative recovery good. Power assisted adenoidectomy is quick, precise and safe. There is good visualization during resection thus improving precision and ensuring complete removal of adenoid tissue.
Pleomorphic adenoma comprises about 80% of the benign salivary gland tumours and is characterised by a slow growth and a clinically benign course. This tumour is known to occur at various other anatomical locations apart from the major salivary glands. Case reports of this tumour arising from the nasal septum, tongue, turbinate, upper lip, lungs, trachea and lacrimal glands have been found in the literature. But case reports of pleomorphic adenoma from the external auditory canal have been extremely few.
Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. In rare cases, however, pleomorphic adenoma presents in various unusual sites such as the nasal cavity, paranasal sinuses, hypopharynx, pharynx, larynx, trachea and lacrimal glands. We present a rare case of 80-year-old woman with pleomorphic adenoma of the nasal cavity.
Pleomorphic adenoma of the base of the tongue is a rare tumour. A case of a 40-year-old female with pleomorphic adenoma of the tongue base is reported here, with a review of the literature. Complete excision of the mass was done transorally under general anaesthesia.
To estimate the average operative blood loss in tonsillectomy and adenotonsillectomy and the various factors affecting it. A prospective study of estimation of blood loss in 100 patients who underwent tonsillectomy and adenotonsillectomy. Data collected included the age, sex, operative indication, clotting time, Hb levels and usage of pre-operative antibiotics. Cold knife dissection method for tonsillectomy and curettage method for adenoidectomy were used. Measurement by calorimetric method of estimation being simple and accurate was used for estimation. Study undertaken at a tertiary referral hospital catering to an urban, semi-urban and rural populace. Blood loss was more in males and increases as age advances both in adenotonsillectomy and tonsillectomy. Blood loss was more in fibrosed tonsils, at lower hemoglobin levels and at higher clotting times. It was less in cases who received pre-operative antibiotics. The average blood losses in males and females during tonsillectomy were 106.91 and 96.26 ml respectively. In adenotonsillectomy, the average blood losses in males and females were 81.44 and 76.82 ml respectively. In our series we found that blood loss in tonsillectomy and adenotonsillectomy depended on various factors like age, sex, the type of tonsillitis, method of dissection, hemoglobin concentration, clotting time and the use of antibiotics. All these factors must be taken into consideration while taking up patients especially those who cannot tolerate blood loss, for surgery.
To evaluate the role of Mitomycin-C in preventing synaechiae formation and ostial stenosis following endoscopic sinus surgery. This prospective study was conducted in VMMC and Safdarjung hospital from November 2007 to August 2008. 30 subjects aged between 16 and 60 of either sex in two groups were included in the study. All these patients with bilateral nasal polyposis underwent endoscopic sinus surgery with topical application of Mitomycin-C and were subjectively and objectively assessed for improvement of symptoms and post operative synaechiae formation. Patients showed improvement in subjective symptoms mainly nasal obstruction and hyposmia as well as decreased incidence of synaechiae formation and ostial stenosis post surgery following Mitomycin-C application. After doing this study we could conclude that Mitomycin-C applied topically following endoscopic sinus surgery was helpful in improvement of symptoms like nasal obstruction and hyposmia as well as decreased adhesion rate and middle meatal antrostomy closure rate. Topical application of Motomycin-C was safe in a dose of 0.4-0.8 mg/ml applied over 5 min and offered significant improvement both subjectively and objectively.
Diphtheria is a forgotten communicable disease and presumed to be under sufficient control so much so that life savings drugs required for its treatment has disappeared from most hospitals. Contrary to this belief, classical diphtheria continues to exist in many parts of India despite extensive immunizations campaigns raising the suspicion of resurgence. The absence of essential drugs in treatment of this condition has further worsened the situation. The expenditure involved in procuring these drugs is yet another constraint. We here by present one such case of adult diphtheria and discuss the problems associated with its diagnosis and treatment.
Carcinoid of the trachea is an extremely rare entity with very few cases reported in literature. The standard of treatment is complete surgical excision with limited role for chemotherapy and also a limited role for radiotherapy as this type of tumour has very low metastatic potential. We describe a case of a tracheal carcinoid which was surgically unresectable, but which showed excellent response to combined modality treatment with sequential multi-agent chemotherapy followed by radiotherapy with complete resolution of disease.
CECT scan of nose and PNS—showing contrast enhancing mass in the right maxillary sinus with destruction of anterolateral wall and medial wall of maxilla  
Postoperative scan—no mass lesion seen  
Juvenile nasopharyngeal angiofibromas are benign but locally aggressive tumors of nasopharynx seen exclusively in adolescent males. Angiofibromas arising in sites other than nasopharynx is very rare. Maxilla is the most frequent site of origin. Extra nasopharyngeal angiofibromas of adult is extremely rare. We present a case of extra nasopharnygeal angiofibroma arising from maxillary sinus in an adult patient which was excised successfully.
The coin as seen on rigid Hopkin's telescopic examination  
Digital X-ray of the neck antero-posterior and lateral views confirming the position (lie) and site (subglottic) of the coin in situ  
The 50p coin after removal  
Foreign-bodies in the aero-digestive tract are a frequent occurrence in ENT practice. The diagnosis and management are based on clinico-radiological findings. We report a case of a 50 paise coin impacted in the adult larynx where the patient came to us 3 days later with the symptom of change of voice and pain in the throat but, surprisingly no dyspnoea or stridor.
Preoperative symptom profile 
Preoperative NCCT nose and PNS findings 
Post operative symptom profile 
Chronic rhinosinusitis (CRS) is a common disease that restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery (FESS) modifies patients symptom profile and to also confirm that FESS is the modality of treatment in patients with refractory CRS. The study was retrospective analysis. 105 patients with symptoms of CRS were included in the study (between August 2006 to July 2009). Patients were assessed for CRS symptoms preoperatively and postoperatively using grading symptoms. Statistical analysis using Chi square test. Leading symptom of CRS was nasal obstruction followed by headache. Furthermore patients reported of anosmia, facial pressure, postnasal drip, purulent nasal discharge, halitosis, dental pain, cough, earache. None of the patients had fever as their complaint. After a postoperative followup of 6 months there was improvement in the symptoms. All minor symptoms had 100% improvement. Nasal obstruction responded best, next followed by (all symptoms P value <0.001). An overall improvement of 86.66% was recorded. The restriction of quality of life in patients with CRS is mainly caused by these symptoms, which can be improved in excellent fashion by FESS in majority of the patients.
Status of MI and IS joint in CSOM 
Status of incus in CSOM 
This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.
Patient characteristics 
Patterns of failure at 1 year 
At 1 year follow up 
To compare the locoregional control rates, survival outcome and toxicity profiles between two groups of patients of squamous cell carcinoma (SCC) of Head and Neck (Stage III & IV) receiving concomitant chemo-radiotherapy with Paclitaxel and Cisplatin. A prospective study was done on 94 previously untreated patients of histopathologically proved squamous cell carcinoma of head and neck region-AJCC stage III & IV (T3 & T4 with N0 -N3, M0) treated with concomitant chemoradiation. The patients were divided into two groups. Group A (44 patients) received concomitant chemotherapy (C.T.) with Paclitaxel 40 mgm/m2 while Group B (50 patients) received concomitant chemotherapy with Cisplatin 40 mgm/m2. All the patients in both the groups responded. In Group A (Paclitaxel + R.T.), complete response was seen in 72.7% and partial response in 27.3%. In Group B (Cisplatin +R.T.) complete response was seen in 52% and partial in 48%. At one year follow up, the locoregional control rate (LRC) in Group A was significantly higher as compared to that in Group B (65.9 vs. 46%, P<0.05) while there was no difference in the disease free survival (DFS) and the overall survival (OS). A 3 year estimate of the LRC, DFS and OS using Kaplan Meier Estimator revealed no difference in the LRC, DFS and OS between the 2 groups. There was a higher incidence of skin and mucosal toxicity with Paclitaxel while the gastro-intestinal and hematological toxicity was more with Cisplatin. No significant chronic toxicity except xerostomia was observed in either group. Paclitaxel has better complete response and locoregional control rates at 1 year as compared to cisplatin. However, there is no difference in the estimated 3 year rates of locoregional control, disease free survival and overall survival between the 2 groups.
Baseline demographic and baseline characteristic of Patients No of patients (n = 40) 
Advanced cancer patients are managed by palliative care and its main aim is to provide best possible quality of life to the patients by symptom management. Pain is the most agonizing symptom experienced by advanced head and neck cancer patients. Control of pain hence requires more attention by the caregiver in order to improve their quality of life. Recently quality of life issues have emerged as a main focus of cancer treatment as compared to conventional increase in survival rate. This study mainly focuses on the effect of palliative drug therapy on quality of life.
Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4 weekly for 3 months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P < 0.05). This study has shown that glycaemic control does not have significant impact on hearing. The hearing threshold is neither affected by insulin treatment nor by the glycaemic control.
Baseline characteristics of both groups 
To compare the efficacy of alkaline nasal douches and decongestant nasal drops following nasal septal surgery. This was a prospective, randomised, single-blind pilot study. Twenty patients were included in each arm of the study undergoing elective nasal septal surgery. The primary outcome measure was nasal congestion. Secondary outcome measures were anosmia, facial pain, nasal discharge, and sneezing/itching. This study does not show any statistically significant difference between the two treatment groups. Symptoms of nasal congestion (P = 0.3), facial pain (P = 0.932), nasal discharge (P = 0.98), sneezing (P = 0.59) and anosmia (P = 0.208) were analysed before conclusion. Three patients in saline group and one patient in the nasal drops group had poor compliance to follow the advice, scoring 2 on a VAS score but the treatment was tolerated well in majority of the patients. No statistical significant differences were noted on analysing the post operative complications in either group. In this study, both nasal douches and decongestant nasal drop were well tolerated. Both treatments provided good postoperative relief from nasal congestion, nasal discharge, sneezing, facial pain and anosmia as days progressed. The post operative examination of the nose among these patients revealed no significant complications in either of the study arm.
In the present study of 331 patients suffering from signs/symptoms of nasal allergy, 9 nasal polyps, allergic conjunctivitis and allergic asthma, who were referred by clinician, were taken up for diagnosis of allergy with skin prick test (Ten et al. Mayo Clin Proc 70(8):783–784, 1995) and subjective improvement of patients by immunotherapy. Out of 331 patients tested 321 patients showed significant positive results and rest of them tested negative for allergy. High incidences of positive results were noted in third and fourth decade age of patients. Dust and pollen allergens were positive in most of the patients compare to insect’s antigens. Among the pollen antigens tested, those of Parthenium hysterophorus was found to be the most common (30%) followed by Prosopis julifora (25%). 75.22% patients were positive to house dust, 19.33% patients were positive to Aspergillus moulds. D. farinae was the most common offender amongst the mites. Patients who attended, allergy clinic in Kamineni Hospitals during the last 4 years were referral patients, who had been on prolonged treatment without much relief. Immunotherapy was advised to patients who were having perineal allergy, in whom, medical treatment had become only palliative. Immunotherapy injections were administered subcutaneously, and their results were monitored.
Ameloblastomas are locally aggressive jaw tumours with a high propensity for recurrence and are believed to be derived from remnants of odontogenic epithelium which does not undergo transformation to the point of enamel formation. Extragnathic ameloblastomas are unusual and primary nasal origin is extraordinarily uncommon.
We report a case of Amyloidosis of larynx in a 60-year-old adult who reported to us with hoarseness of voice of 3 years long duration and no other symptoms. Patient was treated successfully with endoscopic curettage of the mass with no inadvertent ill effects.
To evaluate the extent of posterosuperior bony overhang required to be removed for proper exposure of the incudo-stapedial complex during stapes surgery. Whether an assessment can be made out about the extent of the posterosuperior bony overhang clinically or not. A prospective study. One hundred patients of Stapedial Otosclerosis were included in this study. The direction of the posterosuperior bony canal wall i.e. straight or sloping type was recorded in every patient. All the patients underwent stapedotomy operation under local anaesthesia. The amount of overhang of the posterosuperior bony canal wall required to be removed for adequate exposure of the incudo-stapedial complex during stapes surgery was recorded by using measured right-angled picks of different sizes in mm. The aim of this study is to find out the extent of posterosuperior bony overhang and to know whether the posterosuperior bony overhang is more in straight or sloping bony canal wall. Fifty-seven percent of our patients had a medially sloping posterosuperior bony canal wall and 43% had a straight canal wall, which was noted clinically before surgery. The extent of posterosuperior bony overhang was divided into 4 groups: Gr. A ≤2 mm, Gr. B 2-2.5 mm, Gr. C 2.5-3 mm, Gr. D ≥3 mm. There were 25 patients in Group A, 55 in Group B, 20 in Group C and none in Group D. So majority (i.e. 55%) patients belonged to Group B i.e. 2-2.5 mm. The posterosuperior bony overhang is more in those patients who had straight bony canal than those who had sloping bony canal. This may be clinically assessed and this observation is statistically significant (P < 0.001).
Posterior surface of right temporal bone showing various measurements. A From the uppermost point on posterior wall of sigmoid sulcus to lateral wall of internal auditory canal B Mid point of upper margin of internal auditory canal to superior border of petrous bone C Opening of vestibular aqueduct to lateral edge of internal auditory canal D Midpoint of upper margin of jugular foramen (corresponds to highest point of jugular bulb) to the level of lower margin of internal auditory canal E Vertical and horizontal diameters of internal auditory canal  
Measurements (in mm) from posterior wall of sigmoid sulcus to IAC
Dimensions of IAC (in mm)
Suboccipital retrosigmoid craniotomy with removal of posterior wall of internal auditory canal is preferred by many surgeons operating on acoustic neuromas, as it is a simple and safe approach. To study the topographic landmarks of the posterior surface of the temporal bone. We studied the surgical anatomy of 224 dry adult human temporal bones, measured the various distances on posterior wall of petrous bone relevant for suboccipital surgical approach to internal auditory canal. The internal auditory canal (IAC) lies within 32-44 mm from posterior wall of sigmoid sulcus and within 3-8 mm from the superior border of petrous bone. The point corresponding to highest point of jugular bulb was found between 4 and 9 mm away from the inferior border of IAC. The maximum distance found between bony orifice of vestibular aqueduct and IAC was 14 mm and the minimum distance was 6 mm.The vertical diameter of IAC ranged between 3 and 7 mm. These parameters may help the surgeons for better exposure of internal auditory canal and for avoiding damage to vital surrounding structures.
Different morphologic types of the ST. a classical shape, b confluent shape, c partitioned shape, d restricted shape. st Sinus tympani, p ponticulus, rw round window, pr promontory, ps posterior sinus, s stapes, su subiculum, pe pyramidal eminence, fn facial nerve, jb jugular bulb, *ridge of bone separating the sinus tympani
Different morphologies of ponticulus. a classical morphology, b incomplete ponticulus, c communicating ponticulus. st Sinus tympani, p ponticulus, rw round window, pr promontory, ps posterior sinus, s stapes, pe pyramidal eminence, fn facial nerve
Classification ST's depth based on axial CT scan. a limited sinus tympani, b deep sinus tympani with medially extension respect the facial nerve; c deep sinus tympani with posterior extension respect the facial nerve. fn Facial nerve, pr promontory, rw round window, st sinus tympani
Supratubal recess view with a 45° endoscope in the protympanic space. a right ear with wide perforation of the drum; b magnification of the protympanum with a good view of the anatomic relationship between Eustachian tube and the supratubal
Good knowledge of anatomy is fundamental for every surgeon. Middle ear anatomy is really complex and sometimes is challenging for otologists, who need to explore every single compartment for a radical removal of pathology. With introduction of the endoscope in middle ear surgery, anatomy of middle ear spaces has become wider and clearer due to a better magnification and to the possibility to look "behind the corner". This article is a review of the state-of-art of endoscopic middle ear anatomy with description of every compartment, with particular attention to ventilation pathways and middle ear folds.
The "ancient" variant of schwannomas is a rare subtype of a benign encapsulated neoplasm of nerve sheath. A review of current literature has revealed several reported sites but not in the hypopharynx. Here we report such a hypopharyngeal tumour arising in a 32 year old man, paying particular attention to the potential diagnostic difficulties.
Cavernous haemangioma of the nose is rare, but when it occurs it usually presents with severe epistaxis. This nasal pathology is mostly seen in adult patient patients. Standard approach to dealing with such haemangiomas is surgical resection. A 30-year-old woman presented to General Physician with history of haemoptysis, haematemesis and weakness. She was admitted for investigation of her severe anaemia. On examination there was no obvious source of bleeding in the mouth or oropharynx, and Upper GI endoscopy did not reveal any pathology. She was referred to us after a trivial episode of epistaxis. Anterior and posterior rhinoscopy did not reveal any abnormality. Her extreme anxiety made indirect laryngoscopy and post-nasal space examination difficult but no obvious abnormality was seen. Diagnostic nasal endoscopy was done, and a small haemangiomatous mass was found in the postero superior part of inferior turbinate. Excision of the mass was done under local anaesthesia and sent for histopathological evaluation. The mass on histopathology came out to be Cavernous haemangioma.
MRI showing enhancing mass (angiofibroma) in the sphenoid extending intracranially (extradural) into right cavernous sinus of case no. 5  
Case-12 exposure of most lateral Part of tumour in infratemporal fossa  
Juvenile nasopharyngeal angiofibroma (JNA) are locally growing highly vascular tumours treated primarily by surgical excision (open approach as wide as a mid facial degloving or endoscopic approach). All our patients underwent exclusive endoscopic tumour excision after a pre-operative embolisation. The tumours were completely resected with acceptable blood loss and no recurrences or residual masses were seen. Post-operative morbidity was minimal without external scar-marks. To conclude endoscopic excision is a very effective method to resect JNA even for extensive tumours.
Juvenile nasopharyngeal angiofibroma is a pathologically benign yet locally aggressive and destructive vascular lesion of head and neck region typically affecting adolescent boys. The present article is a retrospective study of surgically treated patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. The study discusses about most common presenting complaints, correlation of preoperative radiological and intraoperative staging and factors affecting recurrence of juvenile nasopharyngeal angiofibroma.
We report an extremely rare case of angiolipoma larynx Case report and a review of the world literature concerning angiolipoma are presented. A case of tumour of the larynx in a 72-year-old male who underwent excision by a lateral pharyngotomy approach. Histopathological diagnosis was angiolipoma. 19 cases of angiolipoma have been reported from head and neck region, none from the larynx. To our knowledge this is the first report in the world literature of angiolipoma larynx.
Necrotising fasciitis is a rare but rapidly progressive and potentially life threatening infection of the soft tissue, involving subcutaneous tissue and deep fascial layer. It may affect any part of the body, but the extremities, abdominal wall, and perineum are most commonly affected. Here we present a case of necrotising fasciitis of the neck and anterior chest wall which is a rare presentation. The risk factor of the disease was uncontrolled diabetes mellitus. We could treat this patient successfully by early recognition, aggressive surgical debridement, intravenous antibiotics, fractional doses of insulin to control diabetes and other supportive measures.
There is lot of controversy over the utility of pre-operative radiology in management of attico-antral disease. This study was done to find correlation between pre-operative HRCT and intra-operative findings in patients with attico-antral disease. Study revealed varying degrees of sensitivity and sensitivity for different aspects of the disease. We conclude that though HRCT given good visualization of the key areas, high levels of false positive and false negative prevent the wholesome reliability on it.
A considerable controversy surrounds the advisability and efficacy of middle turbinate resection in endoscopic sinus surgery. Some are in favor of middle turbinate preservation considering it to be important anatomic and physiological structure and others advocate middle turbinate resection as it improves nasal air flow and decreases synechiae formation. So a study was undertaken to evaluate the efficacy of middle turbinate resection in patients of chronic sinusitis undergoing Functional Endoscopic Sinus Surgery (FESS). 40 patients of chronic sinusitis were selected and divided into 2 groups, group I undergoing FESS with middle turbinate preservation and group II undergoing FESS along with middle turbinate resection. Final results were recorded 6 months after the operative procedure. 50% patients had relief in nasal obstruction in group I as compared to 88% in group II. Postoperative synechiae formation was seen in five patients in group I and in one patient in group II.
Top-cited authors
Sampan S Bist
  • Himalayan Institute of Medical Sciences
Saurabh Varshney
  • All India Institute of Medical Sciences Rishikesh
Rakesh Singh
  • Indira Gandhi Institute of Medical Sciences
Ashutosh Nangia
  • NDMC Medical College, Hindu Rao Hospital, Delhi, India
Daniele Marchioni
  • University of Verona