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Fulltext Bone Changes in Chronic Rhinosinusitis: Pathological or Physiological?

Pokharel M, Khadilkar MN, Sreedharan S, Pai R, Shenoy V, Bhojwani K, et al.

Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):178-184.

PMID: 35813780 DOI: 10.1007/s12070-020-02076-5

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.

Fulltext Predictors of Surgical Outcomes After Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis

Anne J, Sreedharan S, Dosemane D, Shenoy V, Kamath PM, Zubair SM

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):835-841.

PMID: 36452725 DOI: 10.1007/s12070-020-01855-4

Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p

Fulltext Development and Evaluation of an Interprofessional Collaborative Practice Module for the Tracheostomy Procedure for Improved Patient Care

Bhargava A, Sahoo S, Mahdi F, Ali Mohammed C, Dandekar S, Rege N, et al.

Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):225-233.

PMID: 35813773 DOI: 10.1007/s12070-021-03041-6

The Interprofesional collaborative practice (IPCP) is the need of the hour for improved patient care. The procedure of tracheotomy is a life saving procedure and the implementation of the Interprofessional collaborative practice module for the same comprising of the ENT surgeon, Physiotherapist, Nursing staff, OT and Trauma technician decreases the number of complications. This study was carried out to develop and evaluate the Interprofessional collaborative practice module for Tracheostomy. The project has been carried out as a prospective before and after study with the departments of ENT, nursing and Allied health sciences. The facilitators were from the above departments.They were sensitized and developed the Interprofessional education (IPE team),which then collaborated to develop the IPCP module.This IPE team after faculty meetings developed the module with learning objectives, teaching learning methods and methods of assessment. Standardized Readiness scale for Interprofessional Learning Scale (RIPLS), was adopted for the module. The questionnaires for assessment and the module were structured and validated.The template of reflection was compiled for the execution of the module. The students training comprised of the demonstration session, baseline Team OSCE, practice sessions and the final Team OSCE. The baseline and final Team OSCE scores,reflections and RIPLS scores were compared. Team OSCE scores baseline vs Final for IPCP competencies i.e. Competency 1-Values and Ethics for Interprofessional Practice, Competency 2-Roles and Responsibilities, Competency 3-Interprofessional Communication, Competency 4-Teams and Teamwork during Pretracheostomy (PreT),Tracheostomy(T) and PostTracheostomy (PostT) were calculated. Faculty observations: TOSCE scores (pre T/T/postT) significantly improved for all the four IPCP competencies (p

Fulltext Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly

Lim RCA, Loh TL, Yahaya Z, Wan Hamizan AK

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1964-1966.

PMID: 36452519 DOI: 10.1007/s12070-020-01941-7

Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.

Fulltext A Timely Burst: Tuberculous Retropharyngeal Abscess

Chong W, Loh ST, Kulasegarah J, Loh TL, Tengku Kamalden TMIB

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1800-1802.

PMID: 36452768 DOI: 10.1007/s12070-020-01809-w

Tuberculous retropharyngeal abscess is a rare form of extrapulmonary tuberculosis. We describe an immunocompetent teenager who has her tuberculous retropharyngeal abscess ruptured and then diagnosis confirmed by the presence of acid-fast bacilli from the gastric lavage.

Fulltext A Rare Case Report of Unilateral Maxillary Mass from Adrenal Neuroblastoma

Mohamad Yusof AN, Saifudin N, Tengku Kamalden TMI

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1408-1411.

PMID: 36452747 DOI: 10.1007/s12070-021-02560-6

Neuroblastoma is the most common extracranial neoplasm among paediatric patients, which arises from ectodermal neural crest cells. The most frequent primary site of neuroblastoma arises from retroperitoneum, specifically in the adrenal medulla. We present a rare case of adrenal neuroblastoma metastasis to maxillary sinus in a 20 month-old boy presenting with right maxillary swelling for the past 2 months. Computed tomography (CT) scan of paranasal sinus demonstrated right maxillary mass. A biopsy performed via a sublabial approach, surprisingly revealed neuroblastoma. Subsequent further workup depicted a huge right adrenal tumour. He was diagnosed with adrenal neuroblastoma stage 4 and treated with chemotherapy and surgical resection.

Fulltext Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series

Ng BHK, Tang IP

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):731-733.

PMID: 31742052 DOI: 10.1007/s12070-018-1523-0

Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.

Fulltext Challenges in Managing Intractable Epistaxis in a Post-nasal Surgery and Radiated Cancer Patient: A Case Report and Literature Review

Goh SP, Wilfred R, Husain S, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):1096-1100.

PMID: 37206815 DOI: 10.1007/s12070-023-03625-4

Recurrent epistaxis represents an alarming sign that may suggest a sinister aetiology, especially in patients with previous head and neck malignancy. The recognition of certain potentially life-threatening conditions, namely pseudoaneurysm or tumour recurrence, remains prudence to avoid disastrous repercussion. Nasal endoscopy has become an essential tool in otolaryngology. It can aid identify the underlying cause of epistasis and facilitate therapeutic management. On the other hand, radio imaging is highly sensitive in detecting vascular lesions, besides providing a pre-operative mapping if surgical intervention is planned. This paper reported a patient with sphenoidal sinus squamous cell carcinoma in remission presented with torrential epistaxis not relieved with nasal packing. Despite a repeated angiogram and magnetic resonance image, the identification of the source of bleeding remained futile, culminating in an examination under general anaesthesia. The diagnosis of carotid blowout syndrome was made intraoperatively, and the bleeding was temporarily secured with a muscular patch, preceded by the insertion of a vascular stent. The authors wish to highlight the importance of examination under general anaesthesia if radio imaging does not correlate to the clinical findings. Management options for carotid blowout should be tailored to the patients' medical conditions.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-023-03625-4.

Fulltext A Rare Case of Cerebrospinal Fluid Rhinorrhea from Canal of Stenberg

Ngu CYV, Lee TH, Ramachandran K, Liew DNS, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):764-767.

PMID: 37206705 DOI: 10.1007/s12070-022-03347-z

Background: A spontaneous cerebrospinal leak from Sternberg's canal with meningoencephalocele is a very rare clinical entity. Endoscopic repair of the defect is challenging and crucial in identifying the defect. The aim of this case report is to highlight the presence and management with endoscopic surgery in repairing Sternberg canal. Case: 40-year-old woman presents with spontaneous CSF rhinorrhea with no predisposing factors. CT imaging and MRI showed osteodural defect in the lateral recess of sphenoid with meningoencephalocoele lateral to the foramen rotundum. Endoscopic transethmoidal - transphenoidal - transpterygoid approach was used to repair the defect, and patient is well post-operative with least complication from the intervention surgery. Conclusion: Endoscopic approach proved to be the best and safest method in localizing the defect and closure of the leak. Angled scopes and image guided system were used to identify the precise location of the leak.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-022-03347-z.

A Rare Case and Literature Review of Endoscopic Endonasal

Rajoo TS, Ng BHK, Abdullah B, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):996-999.

PMID: 37275000 DOI: 10.1007/s12070-022-03212-z

We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach.

Pharyngeal Lipoma-A Potentially Life Threatening Presentation

Mohd Nor SNA, Ng BHK, Othman N, Tang IP

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5478-5481.

PMID: 36742515 DOI: 10.1007/s12070-021-02803-6

Pharyngeal lipoma of the upper aero-digestive system is extremely rare. It is typically benign, slow growing and symptoms would depend on its size and location. Surgical intervention is often needed especially for large tumour with impending airway obstruction. Here we present a case of potentially life threatening presentation of pharyngeal lipoma.

A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease

Cheah Y, Jumastapha H, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Sep;75(3):2564-2567.

PMID: 37636706 DOI: 10.1007/s12070-023-03792-4

Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.

Myeloid Sarcoma of Temporal Bone: A Rare Manifestation of Relapse Acute Myeloid Leukemia

Goh BS, Tang CL, Tan GC

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1023-1026.

PMID: 31750119 DOI: 10.1007/s12070-015-0930-8

Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.

Fulltext Ex Utero Intrapartum Treatment (EXIT) Into the World: A Multidisciplinary Approach and Outcomes in a Malaysia Tertiary Centre

Oon A, Zulkifli S, Foong YK, Azhar AS, Abdul Ghafar MH, Soo MY

Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):190-195.

PMID: 35813785 DOI: 10.1007/s12070-021-02851-y

Fetal airway obstruction that present during birth are challenging to manage. Cervical and thoracic mass may cause significant airway compression that leads to irreversible fetal morbidity and mortality. With the current advancement in prenatal diagnosis and assessment for surgical planning, EXIT has become an accepted, recognized and preferred option for safe delivery in complex head and neck masses. Ex utero intrapartum treatment (EXIT) is a life-saving procedure that provides time to establish an airway while maintaining uteroplacental circulation. It requires flawless coordination amongst multidisciplinary team to ensure immediate and safe baby deliveries. Retrospective review of EXIT procedures performed from the initial establishment of pediatric otolaryngology service in this centre starting from January 2019 to December 2020. Based on the prenatal diagnosis, five EXIT cases were performed in this centre within 2 years. 4 cases were diagnosed as lymphatic malformation and 1 immature teratoma with cervical and thoracic compression. 4 babies successfully delivered to airway without any complications with 1 death resulting from disseminated intravascular coagulopathy after EXIT. This review of five EXIT procedures aims to bring forth the different outcomes, preoperative planning and sharing our experience as a tertiary and newly established centre. Early prenatal diagnosis, good collaboration and experience among multidisciplinary team ensures good long term outcomes.

Oncocytic Salivary Gland Tumours: Cytological Features and Diagnostic Pitfalls

Prabhakar P, Rao N, Kairanna NV, Shetty S, Singh VK

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):6112-6118.

PMID: 36742835 DOI: 10.1007/s12070-021-02764-w

Oncocytes are epithelial cells having abundant eosinophilic cytoplasm. The presence of oncocytes in salivary glands pose a diagnostic challenge since they can be present in lesions ranging from non-neoplastic, benign to malignant. FNAC is a simple procedure which can aid in the pre-operative diagnosis of these lesions. This study is an eight year retrospective study in which salivary gland aspiration cytology cases having oncocytic cells and with available corresponding histopathology were included. These slides were reviewed for features like cellularity, presence of oncocytic cells, glandular elements, squamoid cells, nuclear atypia, mitosis, lymphoid tissue, necrosis. Twenty cases were included in the study. The mean age of presentation was 60 years showing male preponderance with parotid gland being the most common site of involvement. Concordant diagnosis on cytology and histopathology was seen in 16 cases and discordance was seen in 4 cases. All the discordant cases were reported as benign on cytology but on histopathology they were labelled as acinic cell carcinoma, squamous cell carcinoma, mucoepidermoid carcinoma and an intraparotid lymph node respectively. Review of discordant cases showed subtle findings like ill-formed acini, cytoplasmic vacuolation, goblet cells and dysplastic foci raising suspicion of a different diagnosis. The potential areas of pitfall and cause of discrepancy have been discussed in this study. It is crucial to be aware of the spectrum of lesions in which oncocytes are seen, to enable an accurate diagnosis on cytology. Careful evaluation of smears for subtle clues can minimize errors.

Role of Video Head Impulse Test to Assess Noise Exposure

Saniasiaya J

Indian J Otolaryngol Head Neck Surg, 2024 Feb;76(1):1461-1463.

PMID: 38440558 DOI: 10.1007/s12070-023-04244-9

Noise exposure has been reported to exert numerous detrimental effects on the human population, although most research has centred around hearing damage. Vestibular and balance loss have been demonstrated among industrial workers, although reports on this are still scarce. Vestibular loss increases the risk of falls, especially among industrial workers who are at constant risk. Nonetheless, the ideal investigation tool to investigate vestibular function remains unknown. We aim to review the available literature to elucidate the effect of noise exposure on semicircular canals using a video head impulse test (vHIT). A literature search identified only three studies involving 137 patients (mean age: 44.4). Semicircular canal deficit was found in 50.4% of the included participants, with lateral canal predominantly affected (71%). We highlight the importance of assessing the effect of noise exposure on vestibular function, especially among those prone to occupation-related vestibular loss.

Could Cultural and Background Resilience be the Main Culprit for Neglected Vestibular Dysfunction in Children?

Saniasiaya J

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4114-4115.

PMID: 37974752 DOI: 10.1007/s12070-023-03873-4

Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging.Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-termresults in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptomsthat occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour 1. Whilst measuresto incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to beunfathomed in some parts of the world, notably the South-East Asian region.

High-Riding Inominate Artery: Challenge During Tracheostomy

Wannitta Wong ET, Saniasiaya J, Tharek A, Sallehuddin NS

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3878-3882.

PMID: 37974895 DOI: 10.1007/s12070-023-03944-6

An aberrant vessel presenting as a pulsatile neck mass poses a significant challenge intraoperatively if overlooked during the pre-operative period. We present a case of a high-riding innominate artery (HRIA) just above the suprasternal notch, with the right common carotid artery crossing the midline just inferior to the thyroid gland in a 72-year-old lady referred for tracheostomy. The surgeon operating on the anterior part of the neck must be aware of the HRIA and equipped with sufficient knowledge of interventions that may be adapted to prevent injury. We aim to highlight the importance of careful investigations of subtle signs which may lead to the diagnosis and treatment with a review of various interventions for this unusual condition.

Bilateral Vestibular Atelectasis with Tullio's Phenomenon

Roy S, Kumarasamy G, Salim R

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1599-1602.

PMID: 31750223 DOI: 10.1007/s12070-019-01685-z

Vestibular dehiscence or atelectasis is a rarity known to cause vertigo. This pathology poses many challenges especially in diagnosis and treatment simply due to the scarcity of reported cases. The etiologic factors, disease pathophysiology and complications remain unclear. We report a young adult female who presented with unsteadiness for 2 years associated with headache. Tullio's phenomenon was observed which led to a finding of bilateral vestibular dehiscence involving the medial walls on high resolution computed tomography.

Total Transcanal Endoscopic Approach for Selective Facial Nerve Decompression in Traumatic Facial Nerve Palsy

Sim L, Othman NAN, Hoe KC, Saad MSM

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):3819-3823.

PMID: 36742613 DOI: 10.1007/s12070-021-02662-1

Facial nerve palsy is one of the complications of temporal bone fracture. Several approaches can be used for facial nerve decompression which include the middle cranial fossa approach, transmastoid approach and translabyrinthine approach. When the site of injury is identified at the tympanic segment and perigeniculate area, total transcanal endoscopic approach (TTEA) is an excellent surgical option. This approach is safe and less invasive avoiding external incision and mastoid drilling. Our patient showed recovery to House-Brackmann grade II facial function and reduction of the air-bone gap 6 months after the surgery.

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