Introduction and objective: Neck has a complex anatomy with important neurovascular structures and divided into several compartments. Swellings of different etiology and pathogenesis occur in the neck giving rise to varied signs and symptoms. Surgical management of such swellings may be difficult as their location may be related to important neurovascular structures of neck giving rise to complications if any inadvertent injury happens during surgery. The main objective of this study is to enlighten the difficulties and complications we faced in managing a series of 4 cases with different neck swellings in different compartments. Case series: In this article, we present 4 different cases of neck swellings – cystic hygroma, huge autoimmune thyroid swelling, deep part of submandibular gland sialolithiasis and submental arteriovenous malformations having different etiology arising in different compartments related to different structures with their management. Conclusion: To manage a case of neck swelling proper history, examination, appropriate investigations and thorough anatomical knowledge of site, fine surgical skills with experience may be required to prevent complications and to perform successful surgery.

Introduction: Otomycosis with a perforated tympanic membrane is commonly encountered in clinical practice and can pose a challenge to treat since commonly used clotrimazole ear drops can irritate the middle ear cavity. Here, the objective of the study was to use self-absorbing material like gelfoam soaked in antifungal cream as a patch over the tympanic membrane perforation to reduce seepage of clotrimazole solution into the middle ear and patient's compliance was studied. Materials and Methods: 26 patients presenting to the out-patient department with otomycosis and a perforated ear drum underwent thorough aural toileting followed by placing multiple pieces of gelfoam soaked in clotrimazole cream to patch the perforation. Patients were then asked to continue clotrimazole ear drops for 2 weeks and were followed up. Compliance to treatment in the form of pain tolerance and response to therapy were noted down. Results: 44% of patients complained of pain of which 28% experienced mild and 11% experienced moderate pain at the beginning of therapy. 13 out of 26 experienced mild pain on continuing therapy and all but one were compliant with the entire treatment. 73% of patients had complete resolution at the end of 2 weeks and the remaining 6 out of 26 needed additional week of ear drops for complete resolution. 3 of them with a pinpoint perforation had a healed membrane at the end of the therapy. Conclusion: Using Clotrimazole-soaked gelfoam pieces may be a safer and more effective alternative for enhancing treatment compliance, achieving better disease clearance, and reducing the number of follow-up visits.

Introduction: In myringoplasty, the choice of graft material is crucial for the successful outcome of surgery. The selection of ideal graft is directly related to the size and location of the perforation and also surgeon’s preference. In this study, we compared the efficacy of temporalis fascia graft with tragal cartilage on hearing outcomes. Aim: To compare the hearing outcomes between temporalis fascia graft and tragal cartilage graft in myringoplasty. Objectives: To compare the postoperative hearing improvement between the temporalis fascia graft group and the tragal cartilage graft group. Materials & methodology: In this retrospective study, the records of 40 patients who underwent myringoplasty were included out of which 20 patients (group A) underwent type 1 tympanoplasty with temporalis fascia graft and 20 patients (group B) underwent type 1 tympanoplasty with tragal cartilage graft. Both groups were assessed for hearing on the day before surgery and compared with hearing assessment done 3 months following surgery. Results: There was no statistically significant difference between the postoperative air-bone gap values of Group A and Group B (p < 0.001). Conclusion: This study validates that both graft types effectively restore hearing levels. Keywords : Tympanoplasty, temporalis fascia, tragal cartilage, myringoplasty, grafts

Introduction : Chronic rhinosinusitis with polyposis is a common condition occurring world wide . polyps arising from unusual regions of the nasal cavity and paranasal sinuses are quite rare. One such uncommon entity is the sphenochoanal polyp. There is very less literature on the occurrence of sphenochoanal polyps world wide.1,4,5 It was most commonly seen in children and young adults. Case series : We present three of our cases with isolated sphenoid sinusitis with polyps hanging in to the nasopharynx. These patients were managed surgically by functional endoscopic sinus surgery and removal of polyp under GA . They were all given a course of oral steroids under antibiotic cover post operatively. Conclusion : Although sphenochoanal polyps have been described about in literature they are less common from those occurring from the other paranasal sinuses. A slim probability of immotile cilia syndromes should be kept in mind in case where there are recurrences. A unilateral nasal mass arising from the posterior part of roof of nasal cavity should rise suspicion of malignancy, rathkes cleft cyst and meningoenchephalocoels. Drainage of the middle meatus is crucial in preventing iatrogenic complications.

Introduction Chondroblastic osteosarcoma is a rare malignant bone tumor characterised by the presence of osteoid and cartilagineous components and its occurence in the lateral nasal wall is extremely uncommon which presented with nasal obstruction. Case Report A- 15- year old boy presented with a history of chronic right nasal obstruction lasting for more than 1 year. It was gradually progressive in nature. Clinical examination revealed a large sinonasal mass in the right nasal cavity which extended upto the middle meatus on Anterior Rhinoscopy. On Posterior Rhinoscopy the mass extended into the maxillary sinus . It was senseless on probing and free on medial side and . Laterally, the probe could not be moved as mass was attached. Discussion Chondroblastic Osteosarcoma of the lateral nasal wall and nasal bone is an extremely rare entity and only a few cases have been reported in the literature. It predominantly affects the adolescents and young adults with a slight male predominance. The clinical presentation is often non specific and includes sypmtoms such as nasal obstruction, facial swelling, epistaxis,facial swelling and pain. Radiological imaging including CT and MRI is essential for assessing tumor extent and involvement of adjacent structures. Surgical management with wide excisionis the mainstay of treatment. Adjuvant Chemotherapy and Radiotherapy may be considered depending on the risk factors. Histopathological examination and Immunohistochemistry plays a crucial role in confirming the diagnosis.

INTRODUCTION: Tuberculosis (TB) is a chronic granulomatous, infectious and communicable disease caused by Mycobacterium tuberculosis.A prospective study of patients who presented to us, at a tertiary care hospital, primarily with TB of head and neck was done from June 2023 to July 2024. Patients were categorised into proper category of Anti Tuberculous Treatment (ATT) and were treated according to ATT regimen. The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties and to evaluate efficacy of treatment regimen. All patients were followed up at 3 months and 6 months after starting ATT. A total of 75 patients presented with primary head and neck TB during the study period. MATERIALS AND METHODS: Detailed history was obtained from all the patients. After obtaining history, a detailed clinical examination including General Examination, Systemic Examination and E.N.T. examination was done.All routine investigations were carried out. X ray chest, Sputum AFB and HIV Testing was done for all the patients. Relevant investigations were carried out according to presenting complaint. After diagnosis of Tuberculosis was made these patients were categorised into proper category of Anti Tuberculous Treatment (ATT). RESULT: Most of these (80%) had cervical lymphadenopathy, 8 patients of tubercular otitis media, 3 patients had laryngeal TB, 2 patients had salivary gland tuberculosis, and there was 1 patient each of oral TB & TB perichondritis. 39 were females, and 36 were males. Maximum number of patients were from 21-30 years of age group. In 2 patients of TB otitis media, diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing was improved. CONCLUSION: {1} Diagnosing TB requires a high index of suspicion & proper tissue diagnosis. As the symptoms of EPTB in otorhinolaryngology are varied; hence, all otorhinolaryngologists should be aware of the manifestations of EPTB to suspect and diagnose/ rule out by specific investigations. {2} Tuberculosis of the cervical lymph nodes is the commonest presentation followed by TB otitis media. {3} Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, Histopathological examination is gold standard & newer diagnostic tests such as CBNAAT increases the yield of positive cases and should be used whenever required. {4} In the larynx, true vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. {5} Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. {6} Category I ATT is effective.

Introduction : Penetrating neck trauma though rare (5-10 % of all trauma cases) carries a high degree of morbidity and mortality. They not only pose a challenge to the surgical team but also to the anesthesia team with respect to securing the airway and induction of general anesthesia. Case Report : We report a case of a 9 year old male child who presented with penetrating neck trauma with a metallic trident. Clinically the child was stable and had no signs and symptoms of potential neurovascular injury. Xray examination in antero-posterior and lateral views revealed that the trident had missed the vascular structures of neck and the spine. Surgical removal of the metallic trident was planned after proper informed consent. Patient was intubated in lateral decubitus and the metallic trident was successfully removed from the neck in retrograde manner along the path of entry after incising along the entry wound to dislodge the foreign body from the submuscular plane. Discussion : Relevant literature was reviewed to understand appropriate management strategies. Neck injury by penetrating metallic foreign body should be done in a systematic manner comprising of clinical, radiological and anesthetic assessment. Vascular injury to be assessed at the earliest. Intubation in the lateral decubitus is a very effective method of securing the airway and induction and maintenance of anesthesia under such situations. Conclusion : Exclusion of neurovascular injury in penetrating neck trauma is of utmost importance in selection of imaging modality for the specific case. Multi-disciplinary team approach is desirable in selected cases with an experienced anesthesia team well versed in lateral decubitus intubation, videolaryngoscopy and flexible fibreoptic bronchoscopic intubation.

Introduction: OAE & ABR are screening tests used for newborn screening. The main objective of the study is to determine the incidence of positivity of ABR in newborns detected to have “Refer” in DPOAE in UNHS(Universal Newborn Hearing Screening). Materials & Methods: A prospective observational study was conducted at a tertiary care center over a period of one year from Jan 2020 to July 2021. All neonates will be screened by DPOAE between day 1 to day 28 (first visit). If it is reported ‘Refer’, DPOAE will be repeated either after 6 weeks or on the first immunization day (second visit). If it is again reported as ‘Refer’, the neonate will undergo ABR (third visit). The results were recorded & compiled. The data was analysed statistically using SPSS software (version 20). Results: Out of the 409 neonates, 315 (77.0%) were reported as “Pass” and 94 (23.0%) were reported as “Refer” during DPOAE first visit. The neonates (94) with test result “Refer” in DPOAE 1 (first visit) were considered for DPOAE 2 (second visit) & 77 (83.0%) were reported as “Pass” and 17(17.0%) were reported as “Refer”. The 16 infants who underwent Diagnostic ABR, 6 (37.5%) were reported as “Normal” whereas 10(62.5%) were reported as “Abnormal” group. Conclusion: This study recommends universal screening with OAE & ABR to facilitate early detection of auditory neuropathy and to initiate aural rehabilitation, especially in high-risk groups such as NICU & preterm neonates Keywords: OAE(Otoacoustic emissions), ABR (Auditory Brainstem Response) , UNHS(Universal Newborn Hearing Screening).

Introduction:Nasal septal perforation is a rare but significant clinical condition that may present with symptoms such as nasal discharge, crusting, bleeding, and deformity. Its etiology can be diverse ranging from trauma and infection to autoimmune diseases. We report a diagnostically challenging case of nasal septal perforation following COVID-19-related hospitalization. Case Report: A 48-year-old female with chronic kidney disease, on regular dialysis, presented with foul-smelling nasal discharge, black crusts, and a saddle nose deformity one-year post-COVID-19 ICU admission involving nasal intubation. Initial examination revealed a large septal perforation with extensive crusting and greenish discharge. Preliminary diagnosis was atrophic rhinitis with secondary bacterial infection (E. coli), but symptoms persisted despite treatment. Subsequent biopsy revealed invasive fungal infection with Aspergillus fumigatus. Antifungal therapy with voriconazole was initiated, with initial clinical improvement. However, the patient was later lost to follow-up and subsequently reported deceased due to unknown complications. Conclusion:This case illustrates the diagnostic complexity of nasal septal perforation, especially in immunocompromised patients with multiple possible etiologies such as iatrogenic trauma, fungal infection, and vasculitis. A multidisciplinary diagnostic approach is essential for accurate diagnosis and effective management.