Socio-demographic and Audiological Profile of the Board-Reviewed Applicants for Hearing Handicap Certification in a Tertiary Care Teaching Institute in Eastern India.

To analyze the socio-demographic and audiological profile of the applicants for hearing handicap certification in the Medical Board (henceforth, "Board") of a tertiary care teaching institute. This is a retrospective record review (March 2019-February 2020) from the archival computer database of the institutional Board. The procedure for audiological assessment prior to Board review and thereafter, the evaluation at the Board (computation of hearing impairment) for eligibility for certification was discussed. The socio-demographic profile of the applicants (age, gender, faith) and the types of hearing impairment [HI%; organic (sensorineural, mixed), non-organic (malingering)] were analyzed with relevant statistical parameters. A HI% scale was introduced to classify the severity of the hearing deficit. Of the 163 applicants, 148 had organic hearing loss (average age: 35.4 years; 1.9 times male preponderance) and 15 were malingerers (average age: 35.7 years; 14 times male preponderance). The left ear contributed more to the hearing handicap. Most applicants having sensorineural hearing loss (SNHL; n = 124) were within 10-19 years and 40-49 years (19.35% each), with 12% being ≧ 60 years (age-associated hearing loss). Of the 13 applicants of age ≦ 12 years, eight were diagnosed with brainstem evoked response audiometry, and 10 had HI score of ≥ 70%. Muslim population with SNHL tended to avail certification 1.34 times more than the Hindus. Most of the applicants with mixed hearing loss (MHL; n = 24) were in their fifth and sixth decades (29.2% each), with three times male preponderance. Among the malingerers, the average malingering impairment was 66% (median: 61%; range 44-100%). Among the SNHL population, ~ 30% had HI at 90-100% in contrast to the MHL population of whom 8% had HI at > 90% and 29% had HI at 40- < 55%. Ten applicants among the organic hearing loss group (6.76%) (two with SNHL; eight with MHL) had HI scores of < 40% and were considered ineligible for certification. The outcomes of the review provided a comprehensive account of the socio-demographic profile of the applicants for handicap certification and the type of hearing loss prevailing in a given population. These data, and the severity stratification of the hearing disability through the HI% scale would provide the policymakers and stakeholders with proper directions to work upon.

Perspectives and early experience on endoscopic stapedotomy from a group of "traditional school" otologists.

Background: This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively.Methods: Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters.Results: The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant (P < .001).Conclusions: From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time.

Encountering Chronic Sore Throat: How Challenging is it for the Otolaryngologists?

Objective To explore and diagnose the underlying causes of chronic, recalcitrant sore throat. Methodology In this descriptive, cross-sectional study spanning 3 years (January 2014-December 2016), 1580 patients with chronic sore throat (>12 weeks duration, despite conventional medication) were evaluated for the possible cause(s) in a tertiary care teaching institute of eastern India, through proper history, appropriate investigations, and a self-designed algorithm. Results The common causes for chronic sore throat were chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder, respectively. Allergy, psychiatric illnesses, oral submucous fibrosis, systemic comorbidities (diabetes mellitus, hypothyroidism, uremia, arthritides), stylalgia, Koch's pneumonitis, recurrent aphthous ulcers, and dietary deficiencies formed the other major causes. There was a minimal female preponderance, the female: male ratio being 1.25. About 39% patients were chronic smokers, and 31% addicted to alcohol. Forty-three (2.72%) patients were reactive to HIV 1/2. Conclusion The study provided with a detailed account of the heterogeneous etiology of chronic sore throat, and an overall structured idea on how to approach to its work-up and diagnosis. Proper history taking and appropriate structured investigations are the keys. Chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder were the chief causes of chronic sore throat.

Advancing Cholesteatoma Secondary to Acquired Atresia of the External Auditory Canal: Clinical Perspectives.

Acquired atresia of External Auditory Canal (EAC) is seldom encountered in routine otolaryngology practice. Apart from resulting in moderate-to-severe conductive hearing impairment, it is a potentially dreaded condition which might lead to canal cholesteatoma. Suspected to develop as a consequence of a pre-existing chronic otitis externa/media, the EAC atresia leads to proximal (medial) accumulation of desquamated epithelium and denatured keratin (the canal cholesteatoma) that further leads to aggravation of the chronic otitis, thereby initiating a vicious cycle. The canal cholesteatoma might progress unhindered into the middle ear and mastoid cavity, with its characteristic bone-eroding property, producing complications. A high index of clinical suspicion along with proper imaging are therefore essential to apprehend the disease progression in a patient presenting with an apparently innocuous EAC stenosis/atresia. In this report, we illustrate the clinical details of a young girl with unilateral acquired EAC atresia where canal cholesteatoma had turned extensive, invaded the middle ear cleft, and produced a post-aural fistula, thereby establishing one of the extreme outcomes of chronic otitis.

Nasopharynx- The Secret Vault for Lost Foreign Bodies of the Upper Aerodigestive Tract.

INTRODUCTION: Foreign bodies in the upper aerodigestive tract often get lost following inappropriate attempts at removal. Children may present late with localized infection, posing a challenge to the otolaryngologists in a referral set-up in diagnosing and retrieving such foreign bodies. CASE REPORT: A two-year-old boy presented with refractory purulent rhinorrhea and intermittent low-grade fever. The symptoms suggested rhinosinusitis; however, following a high index of suspicion, he was referred for further evaluation, with the possibility of any hidden foreign object in the upper aerodigestive tract. His soft palate appeared bulged, and his mother informed that he had ingested the cap of a plastic bottle about a month back which could not be retrieved despite several attempts by her. X-ray of soft tissue nasopharynx revealed a radiolucent shadow of a round object resulting in palatal bulging. It was eventually removed by combined endoscopic/transoral approach. CONCLUSION: In a child with a lost foreign body, the nasopharynx should be meticulously explored. This is less common for ingested objects compared to inhaled ones. The diagnosis becomes furthermore challenging when it is not radio-opaque. Naïve manipulations must be avoided and prompt referral should be made to the otolaryngologists for guided removal and minimizing complications.

Mucosal cavernous hemangioma of the maxillary sinus.

Mucosal cavernous hemangiomas of maxillary sinus and the lateral nasal wall are seldom encountered and difficult to diagnose with misleading radiologic features like bone erosion and heterogeneity due to patchy contrast uptake. The overall picture mimicking sinonasal malignancy, it is unclear whether there is true breach in the bone or remodeling due to the lesion's chronicity. Interestingly, it often does not bleed as expected during surgery, questioning the use of therapeutic embolization and pre-intervention vascular shrinkage. The clinical presentation and management protocol of sinonasal cavernous hemangiomas seem greatly individualized. We here present a patient with cavernous hemangioma of maxillary sinus and discuss the distinguishing clinical, histologic and imaging characteristics and subsequent management options, and attempt to establish the findings as the basis of considering it as an important differential diagnosis of radiologically heterogeneous sinonasal mass with suspected bone erosions presenting with nasal obstruction and epistaxis, mostly in young women.

Cystic squamous cell carcinoma of the neck: could a second metastatic focus help?

Squamous cell carcinoma of the neck presenting clinically as predominantly cystic lesion has often been considered as branchiogenic carcinoma in the past. However, such cystic lesions presently constitute a distinct form of head-neck metastasis, and a co-existent second metastatic focus could supposedly help distinguish them from branchiogenic carcinoma. We here present a case where, although the primary remained elusive, the associated spinal metastasis precluded us from diagnosing a cystic squamous cell carcinoma as branchiogenic carcinoma. Thus a second metastatic focus, if found, could add to the existing knowledge to distinguish between a cystic squamous cell carcinoma and the so-called branchiogenic carcinoma, especially when the primary could not be found.

Ameloblastic carcinoma of mandible: facts and dilemmas.

Ameloblastic carcinoma is a rare malignant odontogenic tumor and is considered as the malignant counterpart of ameloblastoma with features of both benign and malignant histology. It may arise de novo or from a long-standing ameloblastoma and is locally aggressive with a propensity for metastasis. With limited documentation, little is known about its pathobiogenesis, with no universal guidelines for management. For clinicians, differentiating ameloblastic carcinoma from ameloblastoma and malignant ameloblastoma in a patient presenting with a suspicious jaw tumor is a challenge due to overlapping clinical features, inconclusive cytology/biopsy reports, different management approaches and inadequate follow-up. Proper knowledge of the disease entity and a high index of suspicion are essential. Here we elaborate the dilemmas in diagnosis and management of ameloblastic carcinoma through presentation of a representative case in a 56-year-old man presenting with a tumor in the mandible.

An atypical rare case of extracranial craniopharyngioma.

We present a case of a purely extracranial, infrasellar craniopharyngioma that initially presented as a mass in nose and nasopharynx. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 55-year-old man presented with 8-month history of progressive headache and epistaxis. Rhinoscopy revealed polypoidal mass in both the nasal cavities and nasopharynx. Pre-operative biopsy suggested Craniopharyngioma. A battery of tests necessary for the diagnosis of Craniopharyngioma was done which excluded other possibilities. Surgical resection was done and histopathology thereafter was confirmatory of Craniopharyngioma. Adjuvant radiotherapy was given to the patient. The patient is doing well. The Rathke's pouch arises from the roof of the primitive mouth and grows toward the brain at the fourth week of gestation. Normally, it loses its attachment with the stomadeum completely by the eighth week of gestation. The craniopharyngeal canal (CPC) extends from the floor of the sella to the vomer and may rarely give rise to ectopic craniopharyngiomas. This case shows that such ectopic tumors may arise anywhere along the CPC. We are documenting this case as an atypical rare case of craniopharyngioma probably originating from tooth primordia.