Head Department Research Articles

Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer.

This study aimed to explore the risk factors of postoperative hypokalemia in patients with oral cancer and to provide a basis for preventing and controlling postoperative hypokalemia. We included 366 patients undergoing oral cancer surgery in the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University from January 2022 to August 2022. Univariate and multivariate analyses were used to determine the risk factors of postoperative hypokalemia. The receiver operation characteristic (ROC) curve was used to quantify the effectiveness of the factors. A nomogram of the risk factors for postoperative hypokalemia in oral cancer patients was developed and validated. A total of 224 patients (61.20%) had postoperative hypokalemia, the lowest serum potassium level (3.50±0.35) mmol/L on the 4th day after surgery, and the highest incidence of hypokalemia (54.68%). Variables with P<0.05 in the univariate analysis were quantified by ROC curve followed by multivariate logistic regression analysis. Results showed an independent correlation with postoperative hypokalemia as follows: preoperative serum potassium<3.87 mmol/L (P=0.008), preoperative serum calcium<2.31 mmol/L (P=0.033), preoperative PNI<49.16 (P=0.032), postoperative drainage volume>264.25 mL (P=0.002). The above variables were constructed into a postoperative hypokalemia risk nomogram and verified, and a good degree of fit was found. The independent risk factors for postoperative hypokalemia in patients with oral cancer were as follows: preoperative serum potassium<3.87 mmol/L, preoperative serum calcium<2.31 mmol/L, preoperative PNI<49.16, and postoperative drainage volume>264.25 mL. Clinical attention should be paid to managing the above high-risk patients. Preventive potassium supplementation should be performed as soon as possible to reduce hypokalemia occurrence.

Clinical efficacy of endoscopic plasma resection of juvenile nasopharyngeal angiofibroma

Objective:To investigate the clinical effect of plasma resection of juvenile nasopharyngeal angiofibroma（JNA） under nasal endoscope. Methods:The clinical data of 12 cases with JNA treated in the Department of Otorhinolaryngology and head and neck surgery of the 940th Hospital from 2015.01 to 2020.01 were analyzed retrospectively. All of them were young males. Imaging examination, digital subtraction angiography（DSA） and selective blood supply artery embolization were performed before operation, and then plasma was used to remove the tumor under nasal endoscope. The patients were followed up for at least 30 months. During the follow-up, the nasal cavity was observed under nasal endoscope and the tumor recurrence was observed by imaging examination. Results:In 12 cases, the vision was clear, the amount of bleeding was less, the operation time was within 2 h, and the postoperative recovery time was short. 12 cases were followed up and no tumor recurrence was found by nasal endoscopy and imaging examination. Conclusion:Selective external carotid artery embolization before operation and plasma resection of JNA under nasal endoscope during operation is a safe and effective treatment, which can effectively improve the cure rate and reduce the recurrence rate.

Clinical analysis of endoscopic transnasal resection of skull base chondrosarcoma

Objective:To explore the surgical techniques and clinical outcomes of endoscopic transnasal approaches in the treatment of skull base chondrosarcomas. Methods:Data from patients diagnosed with skull base chondrosarcomas and treated via endoscopic transnasal surgery at the Department of Otorhinolaryngology and Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, from 2013 to 2022 were collected. This retrospective study analyzed the patients' clinical presentations, histopathological grading, involved sites and extents, and complications following the endoscopic transnasal surgery. Disease-free survival rates were calculated using the Kaplan-Meier method. Results:Complete data from 31 patients showed that the primary tumor site was in the petroclival region in 27 cases（87%）, and the anterior skull base in 4 cases（13%）. Pathological grades were Grade Ⅰ（12 cases）, Grade Ⅱ（16 cases）, and Grade Ⅲ（3 cases）. Total resection was achieved in 25 cases, with residual disease post-surgery in 6 cases. The average follow-up duration was 35.7 months（ranging from 6 to 120 months）. Among those who achieved complete resection, recurrence occurred in 5 cases（5/25）, with a five-year disease-free survival rate of 80%. Postoperative complications included transient abducens nerve palsy in 6 patients and cerebrospinal fluid rhinorrhea in 4 patients. There were no cases of death or permanent cranial nerve palsy. Total resection rate（P=0.001） and involvement of the cerebellopontine angle and jugular foramen（P=0.037） were identified as independent risk factors for residual disease and recurrence of chondrosarcoma. Conclusion:The endoscopic transnasal approach is a safe and feasible treatment option for skull base chondrosarcomas.

Otorhinolaryngologic Manifestations of Long COVID-19 Infection Among Patients at the Quezon City General Hospital

Objective: To determine the otorhinolaryngologic manifestations of long COVID-19 infection among patients consulting at the Quezon City General Hospital. Methods: Design: Cross-Sectional Study Setting: Tertiary Government Hospital Participants:Patients aged 18 years old and above, who previously tested positive for the SARS-COV-2 Test, and consulted with otolaryngologic problems at the Outpatient department, Emergency Room, or were dmitted, or referred from other services to the Department of Otorhinolaryngology Head and Neck Surgery, from October 2022 to January 2023 were considered for inclusion. Results: Out of 150 participants, 127 (84.67%) reported having otorhinolaryngologic symptoms. Five percent (5%) had ongoing symptomatic COVID-19 (4 to 12 weeks) and 11% had post COVID-19 syndrome (&gt;12 weeks). Patients with long COVID-19 had rhinorrhea (54.51%), hyposmia (51.47%), dysgeusia (48.9%), anosmia (48.53%), sore throat (47.8%), ageusia (29.78%), tinnitus (23.53%), ear pain (23.53%), phantosmia (21.33%), and dizziness (11.76%). Out of 25 patients with long COVID, only 2 had pneumonia and 1 was hospitalized and eventually recovered. Conclusion: This study showed a prevalence rate of 16% of long COVID-19 with rhinorrhea as the most prominent symptom. Long-term monitoring is essential and patients who had COVID should be advised to report any lingering illness which may subsequently develop. Physicians should be vigilant and aware of the clinical manifestations of long COVID in order to institute proper intervention.

Individual approach to the treatment of patients with stage III–IV laryngeal and laryngopharyngeal cancer in the Altai territory

Laryngeal and laryngopharyngeal cancer is the most common malignancy within the head and neck. Although there are many treatments for laryngeal and laryngopharyngeal cancer, the treatment still faces great challenging.The aim of the study was to evaluate the effectiveness of personalized treatment and one-year recurrence-free survival in patients with stage III–IV laryngeal and laryngopharyngeal, including postoperative complications (VTE, bleeding) within a year.Material and Methods. From July 2022 to October 2023, 100 patients with stage III–IV laryngeal and laryngopharyngeal cancer were treated in the Department of Head and Neck Tumors at the Altai Regional Oncology Center (AROC), Barnaul. There were 95 men (95 %) and 5 women (5 %). Patients were divided into two groups. Group I patients (n=50) with locally advanced laryngeal cancer underwent laryngectomy followed by radiation therapy with a total dose of 54 Gy delivered to the bed of the removed tumor and lymph node drainage region. Group II patients (n=50) received 3 courses of chemotherapy followed by radiation therapy at a dose of 70–74 Gy.Results. In group I patients, clinically insignifcant bleeding from the upper third of the trachea (in the area of contact with the tracheostomy tube) was observed in 3 patients (6.0 %) 3–4 days after surgery. No VTE during hospital stay and within 6–12 months after completion of treatment was observed. The 1-year cumulative survival rate in this group of patients was 90.0 %. In group II patients receiving chemotherapy, bleeding from a pharyngeal tumor was detected in 4 (8.0 %) patients. There were no signs of VTEO in this group. The 1-year cumulative survival rate of these patients was 70 %.Conclusion. Patients with laryngeal/laryngopharyngeal cancer require an individual approach not only in determining therapeutic strategies, but also in the prevention of VTE and hemorrhagic complications.

3D printed sodium alginate/gelatin/tannic acid/calcium chloride scaffolds laden bone marrow mesenchymal stem cells to repair defective thyroid cartilage plate.

Due to the absence of blood vessels, cartilage exhibits extremely limited self-repair capacity. Currently, repairing laryngeal cartilage defects, resulting from conditions such as laryngeal tumors, injury, and congenital structural abnormalities, remains a significant challenge in the Department of Otolaryngology, Head and Neck Surgery. Previous research has often focused on enhancing the mechanical properties of synthetic materials. However, their low biological activity and weak cell adhesion necessitate compensatory measures. This study aims to capitalize on the advantages of natural materials in cartilage tissue engineering. Sodium alginate, gelatin, tannic acid, and calcium chloride were utilized to prepare bioinks through cross-linking for application in 3D printing cartilage scaffolds. Bone marrow mesenchymal stem cells with multidirectional differentiation potential were chosen as seed cells, with appropriate growth factors incorporated to promote their differentiation into cartilage during in vitro culture. The scaffold laden cells was subsequently implanted into rabbit thyroid cartilage plate defects at the appropriate time. HE staining, toluidine blue staining, Masson staining, and collagen type II staining were employed to assess cartilage defect repair at 4, 8, and 12 weeks, respectively. Results demonstrated that scaffolds made from natural materials could emulate the mechanical properties of fresh cartilage with commendable biocompatibility. Stained sections further confirmed the efficacy of the composite hydrogel scaffolds identified in this study in promoting rabbit thyroid cartilage plate restoration. In summary, this study successfully fabricated a natural material scaffold for rabbit laryngeal cartilage tissue engineering, thereby furnishing a new idea and experience for the clinical application of laryngeal cartilage defect reconstruction.

Assessment of optical coherence tomography and optical coherence microscope for oral cancer diagnosis: a clinical study

Objective: To explore and evaluate the feasibility and accuracy of using optical coherence tomography and optical coherence microscope (OCT/OCM) for diagnosis of oral cancer. Methods: In this study, OCT/OCM was utilized to image the oral mucosa specimens. A total of 289 ex vivo oral mucosa specimens were collected from 68 patients with oral cancer who were hospitalized at Department of Oral and Maxillofacial Head and Neck Tumors, Capital Medical University School of Stomatology, between January 2021 and February 2023, resulting in a dataset of 1 445 OCT/OCM images. By observing the characteristic patterns in the OCT/OCM images, including normal oral mucosa, epithelial abnormal proliferation (mild, moderate, severe), and oral cancer, these patterns were matched with corresponding pathological images. A diagnostic study was conducted, employing pathological diagnosis as the gold standard and utilizing a double-blind experimental design involving three diagnostic evaluators who participated in the analysis and diagnosis of OCT/OCM images. Results: The OCT/OCM images demonstrated good correlation with the corresponding pathological images, and diagnostic criteria were established based on the comparative results. In the diagnostic study involving three investigators, the accuracy was 82%, sensitivity was 84% (95%CI: 80%-88%), and specificity was 81% (95%CI: 77%-85%). There was a high level of agreement among the observers (kappa=0.614), indicating substantial concordance in the diagnostic results among the three investigators. Conclusions: This study demonstrates the potential of OCT/OCM for diagnosis of oral cancer. The technology accurately distinguishes between normal oral mucosa, epithelial abnormal proliferation and oral cancer.

Application of nasal pedicle mucosal flap based on nasal blood supply in reconstruction of nasal skull base defects

Objective: To evaluate the clinical efficacy of nasal pedicle tissue flap based on nasal blood supply in the reconstruction of nasal skull base defects. Methods: A retrospective analysis was conducted on 138 clinical cases of skull base tumors and cerebrospinal fluid rhinorrhea treated at the Department of Otolaryngology, Head and Neck Surgery at Xiangya Hospital of Central South University from March 2017 to March 2023. A total of 79 males and 59 females were enrolled, aged from 8 to 82 years, with a median age of 51 years, including 108 patients (78.3%) with skull base tumors and 30 patients (21.7%) with cerebrospinal fluid rhinorrhea (and/or meningoencephalocele). During the surgery, 88 cases (63.8%) were repaired with nasal septal mucosal flaps pedicled with the posterior nasal septal artery, 14 cases (10.1%) with mucosal flaps pedicled with the anterior ethmoidal artery on the lateral wall of the nasal cavity, 6 cases (4.3%) with mucosal flaps pedicled with the posterior lateral nasal artery on the lateral wall and nasal floor, 12 cases (8.7%) with mucosal flaps pedicled with the anterior ethmoidal artery and posterior ethmoidal artery, and 18 cases (13.0%) with nasal septal mucosal extension flaps pedicled with the sphenopalatine artery or internal maxillary artery. Patients were followed up for 12 to 72 months postoperatively. Endoscopic examination or skull base enhanced MRI was performed to assess the growth and tumor recurrence in the skull base repair area. The t-test was used for statistical analysis. Results: Among 138 patients, primary repair was successful in 133 patients (96.4%), while 5 patients (3.6%) experienced postoperative cerebrospinal fluid rhinorrhea. These 5 patients all underwent nasal septal mucosal flap repair with the posterior nasal septal artery as the pedicle. Complications included 1 case of mucosal flap necrosis, 1 case of mucosal flap central perforation, and 3 cases of mucosal flap survival peripheral leakage, of which were all successfully treated with a second repair. Conclusion: The use of nasal pedicle mucosal flap based on nasal blood supply is a reliable, safe, and effective technique for repairing skull base defects.

Preliminary efficacy of individualized genioglossus advancement with 3D printing in the treatment of obstructive sleep apnea with micrognathia

Objective: To investigate the preliminary efficacy of 3D printed individualized genioglossus advancement (GA) for the treatment of obstructive sleep apnea (OSA) in adults with micrognathia. Methods: The OSA patients with retropalatal and retroglossal collapses due to micrognathia underwent 3D printed individualized GA combined with Uvulopalatopharyngoplasty(UPPP) in Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Clinical data including pre-and post-operative polysomnography (PSG), cephalometric measurements of genioglossus advancement, patient-reported symptom and surgical complications were collected. A comparison of pre-and post-operative data was conducted using paired t-tests. Results: Nineteen OSA patients with micrognathia successfully underwent 3D printed individualized GA combined with UPPP, and achieved an actual mean genioglossus advancement distance of (9.0±1.4) mm compared to the planned distance of (9.4±1.0) mm preoperatively (t=0.81, P=0.427). Among the 14 patients followed up for more than 6 months, the mean AHI reduced by 60.4% at 6 months postoperatively, with 5 cases (5/14) cured and 5 cases (5/14) showing significant improvement, resulting in an overall surgical response rate of 10/14. All patients expressed satisfaction with their postoperative facial appearance, with 13 cases perceiving an improvement in attractiveness. Two patients reported temporary genial numbness, and one patient experienced temporary mandibular occlusal asthenia. Conclusion: The 3D printed individualized GA combined with UPPP effectively reduces AHI in adult OSA patients with micrognathia, accompanied by a low incidence of surgical complications and high patient satisfaction regarding postoperative facial appearance.

Application of electronic laryngoscope combined with narrow band imaging endoscope and its classification in the diagnosis of vocal cord leukoplakia

Objective:To investigate the clinical value of electronic laryngoscope combined with narrow band imaging（NBI） endoscope and its classification in the diagnosis of vocal cord leukoplakia. Methods:A retrospective analysis was performed on 115 cases of patients treated in the Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital from September 2020 to November 2022. All 115 cases were diagnosed with vocal cord leukogramma using the electronic laryngoscopy and narrow band imaging endoscopy, followed by pathological examination in the outpatient tissue biopsy. The morphological characteristics of vocal cord leukoplakia and the correlation between narrow band imaging classification and pathological results were investigated. Results:Among 115 cases of vocal cord leukoplakia, 46 cases（40.00%） were diagnosed as benign lesions. Low grade intraepithelial neoplasia occurred in 29 cases（25.22%）. High-grade intraepithelial neoplasia（including carcinoma in situ） occurred in 22 cases（19.13%）. Invasive carcinoma（including suspected invasive carcinoma） was found in 18 cases（15.65%）. There were no statistical differences in the unilateral and bilateral distribution of vocal cord leukoplakia and pathological results（P>0.05）, but there were statistical differences in the size, thickness, lesion uniformity, clear boundary, pre-invasion commissure, symmetry,age over 55 years old, morphological classification, NBI classification and pathological results distribution（P<0.05）. The two-by-two comparison among the three groups of morphological classification（flat type, raised type, rough type） showed that P<0.017 was only compared between flat type and rough type, and P>0.017 was compared between the other two groups. The pairwise comparison among the three groups of NBI classification（Ⅲ, Ⅳ, Ⅴ） was statistically significant（P<0.017）. There was a high correlation between NBI classification and pathological diagnosis, and the correlation coefficient was 0.705（P<0.05）. The risk of high intraepithelial neoplasia and cancerization in type Ⅳ was 9.125 times higher than that in type Ⅲ, and the risk of high intraepithelial neoplasia and cancerization in type Ⅴ was 271.078 times higher than that in type Ⅲ. The area under the curve of morphological classification and NBI classification were 0.672 and 0.896, respectively. Conclusion:There is a high match and correlation between NBI classification and pathological diagnosis. Electronic laryngoscope combined with narrow band imaging endoscope has a high diagnostic value for vocal cord leukoplakia, and a strong predictive ability for malignant leukoplakia.

Development of a risk index for cognitive decline predicted by adverse radiation events and diet in older oral cancer patients

Professor Norimasa Ogama, Faculty of Nursing, Soka University, is interested in how symptoms such as dry mouth and changes in taste in elderly oral cancer patients could predict the risk of decline in cognitive function with the use of different sensory food experiences. He is developing an index to predict this. While previously at the Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Ogama saw a range of problems among patients caused by radiation and chemotherapy, including reduced eating and swallowing function, changes in body image and ongoing issues with being able to eat and speak. He began to consider how it might be possible to improve quality of life for such patients, including the ability to enjoy food. This inspired him to work to develop an oral rehabilitation programme that takes into account post-operative life evaluation and its influencing factors in order to significantly increase patientsâ–™ life satisfaction. Ogama and the team are developing a risk index for cognitive decline predicted by the adverse events of radiation and the diet of elderly patients with oral cancer. The goal is to accurately determine the risk of cognitive decline early based on changes to eating preferences and the taste of food, as well as worsening of oral mucositis and symptoms of dry mouth due to radiation therapy. This will be done through the concept of ‘eating deliciously’, based on personal preferences and characteristics.

Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis.

We planned this study considering that complications of deep neck infections can be seriously life threatening. To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity. This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications. There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years. Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.

Changes functional prediction of ear canal flora in chronic bacterial otitis externa.

To investigate ear canal microflora's structure, composition and function in patients with chronic bacterial otitis externa. A case-control study design method was used to collect the ear canal secretions from 14 patients with chronic bacterial external otitis (CB group) and 14 healthy controls (H group) treated in the Department of Otolaryngology and Head and Neck Surgery in the First Affiliated Hospital of Hainan Medical University. 16S rRNA high-throughput sequencing technology was used to sequence the ear canal microflora's V3 ~ V4 region gene amplification products in the participating population. The α diversity of ear canal microflora in 2 groups was analyzed. Based on the weighted Unifrac distance, principal coordinate analysis was performed to compare the β diversity of ear tract microflora between the two groups. The differences in ear microflora at phylum and genus levels were analyzed. PICRUSt2 function prediction and BugBase phenotype prediction were also performed. α diversity analysis showed that the diversity and richness of auricular microflora in the CB group were significantly lower than those in the H group. β diversity analysis showed that there were some differences between the two groups. At the phylum level, the relative abundance of Bdellovibrionota, Campylobacterota, and WPS-2 in the microbiota of patients in the CB group was significantly lower than that in the H group, and the differences were statistically significant. At the genus level, the relative abundance of Pseudomonas, Acinetobacter, Pelomonas, Sphingomonas, Bradyrhizobium, Brevundimonas, Enhydrobacter, Actinomyces, Paracoccus and Chryseobacterium in the ear canal of Group H is significantly higher than that of Group CB. Functional prediction of PICRUSt2 suggests that amino acid biosynthesis and bacterial microbiota may be related. In BugBase phenotypic prediction, the contribution of aerobic phenotype in group CB was significantly lower than that in group H. The diversity and abundance of the ear canal flora of patients with chronic bacterial otitis externa were significantly lower than those of the healthy population, and their bacterial colony structure was significantly altered. Dysbiosis of the ear canal flora may be an important cause of chronic bacterial otitis externa.

Upper Esophageal Fetal Rhabdomyoma: A Case Series of 4 Children and Review of Literature.

Objective: The aims of the present study were to provide objective evidence for identifying fetal rhabdomyoma (RM) in the upper esophagus of children, enhance clinical understanding of the diagnosis and treatment of this condition, and optimize the treatment strategy for fetal RM. Methods: The clinical medical records of 4 children with upper esophageal fetal RM were retrospectively collected, and were admitted to the Department of Otolaryngology, Head and Neck Surgery at our hospital between July 2016 and July 2022. Their clinical, histological, and therapeutic characteristics were analyzed in combination with the literature. Results: Four children diagnosed with upper esophageal tumors were included and all of them underwent resection of the upper esophageal tumor with esophageal-pharyngeal reconstruction, and 2 of them underwent prophylactic tracheotomy due to recurrent laryngeal nerve adhesion. Preoperative biopsy was performed in 2 cases (case 2 and case 4), while intraoperative frozen section analysis was conducted in the other 2 (case 1 and case 3), with pathological results consistent with fetal RM. Patients were followed up for 25 to 96 months after the surgery. So far, only 1 patient has experienced a recurrence of fetal RM and underwent a second surgical resection to remove the tumor. Conclusion: Fetal RM is a benign tumor prone to recurrence, and complete excision is the preferred optimal treatment. Clinicians need to understand and master the management algorithm for fetal RM to standardize its diagnosis and treatment.

Implications of Middle Cranial Fossa Dural Plate, It’s Importance in Sclerotic Mastoid to Identify Mastoid Antrum and to Avoid Complications

Abstract Aim: To correlate middle cranial fossa dura with mastoid antrum in sclerotic mastoids with absent/rudimentary spine of Henle. Materials and Methods: The prospective study was conducted in 38 patients with chronic otitis media having rudimentary or absent spine of Henle in the Department of Otolaryngology and Head and Neck at R. L. Jalappa Hospital and Research Center from December 2021 to December 2023. Results: In our study, majority were males with involvement of the right ear more than left. Most of the patients had symptoms of chronic ear discharge with moderate conductive hearing loss. Some patients had associated ear pain, tinnitus and vertigo. Four patients had large central perforation. Twenty-eight cases had sclerotic mastoid and diploic in 10 patients in high-resolution computed tomography of temporal bone. Nine patients had high jugular bulb, 30 had low lying dura, and 15 with anteriorly placed sigmoid sinus. All cases underwent cortical mastoidectomy with tympanoplasty and epitympanotomy in seven cases. Intraoperatively, 9 cases had absent spine of Henle and 29 had rudimentary spine of Henle. Conclusion: In sclerotic mastoids with absent or rudimentary spine of Henle to address the antrum is challenging when there is anteriorly placed sigmoid sinus and low-lying or undulating dura. The definite reference to approach mastoid antrum is to follow the pinkish hue of the dural plate with least complications.

An Observational Study on the Treatment Outcomes of Adenotonsillar Hypertrophy in Children

Background: Adenotonsillar hypertrophy, marked by abnormal enlargement of the adenoids and tonsils, is common in children and can cause various health issues. For severe cases, surgical intervention, mainly adenotonsillectomy, is often recommended and has proven effective in improving airway obstruction, sleep quality, and overall health outcomes. This study aimed to assess the treatment Outcomes of adenotonsillar hypertrophy in children. Methods: This prospective observational study was conducted in the Department of Head &amp; Neck Surgery (ENT), Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from January 2023 to June 2023. A total of 57 children with primary symptoms of mouth breathing, snoring, and sleep disturbances were purposively enrolled as study subjects. For data analysis, MS Office tools were applied. Results: Most participants (61.4%) were aged 2-5 years and female (60%). All participants (100%) reported symptoms of nasal blockage, snoring, and mouth breathing. A majority (61.4%) had grade 2 tonsillar hypertrophy. After 3 months of medical treatment, 57.9% experienced complete relief of nasal symptoms, including sleep apnea, 24.6% showed moderate improvement, and 17.5% saw no improvement. Conclusion: Intranasal steroids, combined with oral amoxicillin e-clavulanic acid and montelukast, reduce adenotonsillar hypertrophy symptoms and lower surgical intervention rates. This approach targets inflammation and infection, potentially improving patients' quality of life. More studies are needed to establish guidelines and optimize treatment.

Audit of hypocalcemia as a clinical marker following total thyroidectomy: a retrospective chart review

Background: Surgical removal is one of the most important treatment options for the thyroid swellings. Metabolic derangement due to injury to parathyroid glands is one of the complication to be dealt with frequently. The aim of this study is to assess the incidence of postoperative hypocalcemia after total thyroidectomy and to analyze various pre-operative risk factors that lead to the same. Methods: A retrospective study was conducted on patients who underwent total thyroidectomy at department of ENT and head and neck surgery over a period of 2 years. The level of post-operative serum calcium was analyzed, to determine the incidence of hypocalcemia. In all the patients the following parameters were assessed – age, gender, pre and post-operative serum calcium and type of thyroid disease. Unpaired t test and Mann-Whitney U test was used for statistical analysis. Results: The total study population was 65. The mean age of the patients was 45.5 and 83% of the patients were female. The incidence of postoperative hypocalcemia was noted to be 37%. Pre-operative serum calcium (p&lt;0.0001) was found to be significant risk factor (p&lt;0.05) for prediction of post-operative hypocalcaemia. The same was not noted between variables like age, gender and type of thyroid disease and incidence of hypocalcemia. Conclusions: A thorough knowledge of normal anatomy of neck, possible anatomical variations and parathyroid physiology is of paramount importance to prevent complications during thyroid surgery. Early identification of hypocalcemia can be achieved only by stringent postoperative monitoring, which in turn will reduce morbidity to the patient.

A Prospective Clinicopathological Study of Cervical Lymphadenopathy in a Head and Neck Unit of a Tertiary Referral Centre

Background and Aims: This study aims to investigate the clinicopathological profile of cervical lymphadenopathy in a tertiary referral centre. The findings will contribute to a deeper understanding of the disease spectrum, aid in accurate diagnosis, and help in improving patient treatment and outcomes. Methodology: This is a prospective study conducted in the Department of ENT, Head and Neck Surgery, Apollo Hospital, Chennai, between June 2022 and May 2023. The clinicopathological profile of all patients was analysed. The final histological diagnosis and the preoperative Fine Needle Aspiration Cytology (FNAC) were correlated. The primary tumour was identified in cases with metastatic secondary tumours in the neck. Results: Among the 80 patients in our study, 67% had a benign aetiology (most common was tuberculosis), and 33% had a malignant aetiology (most common was Hodgkin’s Lymphoma). Gender distribution was equal, with those between the ages of 35 and 60 more frequently affected. The nasopharynx (30%) was the most likely location of the occult primary, followed by the thyroid (20%) and larynx (20%). In detecting TB, FNAC had a sensitivity of 75.5% and a specificity of 98%; in detecting lymphomas, it was 64% and 100%; in detecting metastatic secondaries, it was 80% and 100%; and in detecting reactive lymphadenitis, it was 79% and 86%. Conclusion: Cervical lymphadenopathy is a common entity requiring careful evaluation and treatment. PET scans prove invaluable in detecting occult primary tumours. FNAC is an initial, cost-effective diagnostic tool. However, biopsy is indicated in specific conditions to obtain accurate diagnosis to enable prompt treatment.

Current Trends in Clinico-Bacteriological Profile and Antimicrobial Susceptibility Pattern in Active Chronic Suppurative Otitis Media (Safe and Unsafe) at a Tertiary Care Center in Uttarakhand: An Observational Study.

Otitis media is defined as inflammation of the middle ear due to any cause that may also involve any contiguous pneumatized portion of the temporal bone. It is also one of the most common diseases of childhood after viral upper respiratory tract infection. As a result of the widespread availability of over-the-counter topical antibiotics and the irrational use of these agents, there is a development of multidrug-resistant bacteria. The aim of this study was to assess the current bacteriological profile and antimicrobial susceptibility pattern in clinically diagnosed cases of active chronic otitis media (COM) at a tertiary care center in Uttarakhand. The proposed observational cross-sectional study was conducted in the Department of Otolaryngology and Head and Neck Surgery and Department of Microbiology of Government Doon Medical College Hospital, Dehradun, over a period of 18 months from August 2022 to January 2024. One hundred and thirty-seven cases of active COM fulfilling the inclusion criteria were recruited in the study. Under strict aseptic conditions, pus samples were collected from the middle ear using two sterile cotton swabs under microscopic examination and sent to the microbiology lab for pathogen identification and isolation. The isolated organisms were subjected to antibiotic susceptibility testing using VITEK-2 as per the latest Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: In the present study, the most common age group affected by COM was between 18 and 30 years with female predominance. Pseudomonas aeruginosa (33.6%) was the predominantly isolated organism followed by Staphylococcus aureus (17.8%). Considering the antibiotic susceptibility, Pseudomonas aeruginosa was susceptible to piperacillin/tazobactam and meropenem while least sensitive to levofloxacin and ciprofloxacin. Staphylococcus aureus was susceptible to linezolid, daptomycin, and vancomycin. The maximum resistance of Staphylococcus aureus was observed to ciprofloxacin and levofloxacin. The study of changing clinico-bacteriological profile and antibiotic susceptibility pattern in cases of COM due to variations in the geography and environment of the study population can help to guide appropriate antibiotic treatment and thus prevent the development of multidrug-resistant bacteria.

How to Disclose Internal Carotid Artery Dehiscence in Patients With Eustachian Tube Dysfunction: Cone Beam Computed Tomography or High-resolution Computed Tomography?

Objective: To compare the prevalence of internal carotid artery dehiscence (ICAD) on high-resolution computed tomography (HRCT) and cone beam computed tomography (CBCT) in patients with Eustachian tube dysfunction (ETD). Study Design: A prospective, cohort study. Setting: The outpatient clinic at the Department of Otorhinolaryngology, Head and Neck Surgery at Gødstrup Hospital, Denmark (tertiary referral center). Patients: Patients &gt;18 years of age diagnosed with long-standing ETD undergoing HRCT and/or CBCT prior to balloon Eustachian tuboplasty. Intervention(s): Patients had either initially HRCT and later CBCT performed (HRCT + CBCT group) or solely CBCT (CBCT group). Main Outcome Measure(s): Prevalence of ICAD assessed with HRCT and CBCT. Results: A total of 23 patients were included in the HRCT + CBCT group and 36 patients in the CBCT group. In the HRCT + CBCT group, ICAD was found in 13 temporal bones (28.3%) with HRCT and 7 temporal bones (15.2%) with CBCT (P = 0.0003). No new cases of ICAD were found with CBCT. In the CBCT group, ICAD was found in 6 temporal bones (8.3%). In both HRCT and CBCT, patients suffered from ETD in 61.5% of the ears where ICAD was found. Conclusions: CBCT has a higher specificity than HRCT in diagnosing ICAD in patients with ETD while at the same time using less radiation.