ENT Department Research Articles

Outcome of Preoperative Oral Steroids on Patients With Sinonasal Polyposis

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery.Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups.Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed.Conclusion: Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Use of blue laser in a patient with postop restenosis of the choana after multiple surgical interventions for congenital choanal atresia

One of the most common complications following surgical interventions in nasal cavity is synechiae and scarring, which often leads to restenosis, particularly in cases of choanal atresia. Laser technologies, especially blue laser (wavelength 445 nm), represent a promising opportunity in rhinology for addressing these complications. Objective: to study the effectiveness and safety of blue laser for nasal synechiae and stenosis surgery in patients with congenital choanal atresia after multiple surgical interventions. In ENT department of Veltishev Institute 4 children have undergone choanal reconstruction following multiple attempts of choanoplasty. A clinical case of a 6-year-old girl diagnosed with bilateral complete choanal atresia, who underwent six surgical interventions within two years and was admitted with complete choanal restenosis is presented. The most common cause of restenosis after surgery for hoan atresia is the formation of synechiae in the surgical area. Traditional dissection of the synechiae in most cases leads to repeated stenosis. To reduce the recurrence rate in the patient, the authors used a blue laser. The blue laser demonstrated high effectiveness in the surgical treatment of postop restenosis, minimizing surgical trauma, preventing recurrences, and improving the patient’s quality of life. The results confirm the feasibility of using lasers in rhinology as a preferred method for treating restenosis and enhancing respiratory function.

The Packed Epistaxis Patient: Risks of Rebleeding? A Pilot Study to Inform Outpatient Management of Packed Patients.

Current common practice for patients with idiopathic epistaxis which requires nasal packing is to admit as an in-patient for overnight observation. Anecdotally, many patients do not re-bleed, so admissions may be unnecessary. Several factors have been suggested to be associated with an increased risk of re-bleeding, such as hypertension, anticoagulant use, and male gender. We set out to investigate these factors, to create a local guideline to identify patients who may be safe to discharge with a pack in situ. We collected the data on the most recent admissions in our department, who each received a non-absorbable nasal pack for idiopathic epistaxis (n = 100). Data points included age, gender, anticoagulation status, and comorbidities. Data from 100 patients were audited. Of those, 13 were found to have re-bled through their packing (13%). Statistically significant predictors of re-bleed were as follows: Male sex (OR = 9.81, P = .048, 95% CI 1.02-94.11), aspirin use (OR = 8.11, P = .047, 95% CI = 1.03-63.79), hypertension (OR = 8.14, P = .040, 95% CI = 1.10-60.26), and age (OR = 0.93, P = .018 95% CI = 0.88-0.99). Re-bleed in patients managed with non-absorbable packing for idiopathic epistaxis is uncommon. Risk factors may include male sex, hypertension, and aspirin use. ENT departments nationally may consider discharging patients' home with pack in situ, for removal as an outpatient, in the absence of these risk factors.

Anatomical investigation of the venous system in pedicled nasal septal mucosal flap and its application in nasal skull base reconstruction

Objective: To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers. Methods: Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap. Results: The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived. Conclusions: The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

A Study of Causes and Clinicopathological Changes of Patients Presented with Hoarseness of Voice in the ENT Department of Hilla Teaching General Hospital, Babylon, Iraq

Abstract Background: Hoarseness of voice (HOV) is defined as abnormal changes in the quality of voice. It may be caused by many diseases related to the upper aerodigestive tract system. Proper knowledge about the causes and clinicopathological changes leading to HOV is very important for the early detection and treatment of the causative pathology. Objective: To investigate the causes, incidence, age, occupation, and sex predilection for HOV. Materials and Methods: This prospective study was carried out on 200 patients referred to the Eyes, Nose, and Throat (ENT) Department of Hilla Teaching General Hospital, Babylon, Iraq, from September 2017 to September 2019 complaining of HOV for more than 10 days. The ENT examination was conducted using a fiberoptic flexible laryngoscope. Radiological examination by plain X-ray of the neck and chest, computed tomography scans of the head, neck, and chest, and a direct laryngoscopy exam. Under general anesthesia, and biopsy is taken from suspected pathology (if needed). Results: Out of 200 patients, the age group between 31 and 40 years was most commonly seen. Laborers occupation 30% farmers 35% were the major groups affected. Smoking habits were found in 40% of patients with HOV. The most common causes of HOV were acute and chronic laryngitis, including acute viral laryngitis, acute voice abuse, laryngeal trauma after thyroid surgery, vocal cord (VC) nodules, laryngeal polyps, and laryngeal edema. The second most frequent causes are neoplastic growths in the larynx (mostly supraglottic) and hypopharynx. The least frequent causes of HOV are seen due to congenital pathologies such as laryngomalacia and congenital VC palsy. Conclusion: Proper and detailed history, good ENT examination, and the investigation of patients with HOV are important factors in the early detection and treatment of causative pathology.

A retrospective analysis of syphilis cases with a focus on otolaryngology at a university hospital

ObjectivesIn recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital. MethodsWe retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses. ResultsOur hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments. ConclusionDiagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment.

Botryomycoma of the Nasal Vestibule: A Case Report from the Commune VI Referral Health Center of the District of Bamako/Mali

Pyogenic granuloma or botryomycoma or lobular capillary hemangioma is a benign proliferation of capillaries, precisely skin and mucous membranes. This pathology is considered rare in terms of nasal cavities. But cases are increasingly related to literature. Thus, this study concerns a case sitting at the level of the nasal vestibule. He is an adult of 58 years and male sex, who came for consultation in the ENT department at the commune VI reference health center of the district of Bamako / Mali, presenting as a reason for consultation a right nasal obstruction. The interrogation revealed that the start dates back to about eight months and marked by a serous rhinorrhea and an associated homolateral epistaxis of headaches. No predisposing factor and no medico-surgical history has been found. The scanner allowed us to define the contours of the mass and to guide the therapeutic decision. The mass was completely removed surgically into endonasal without incidence. Histological examination of the surgical sample concluded that a lobular capillary hemangioma. The patient was followed for 2 years without recurrence or complications. Because of its rarity in our context, we recommend particular attention to ENT specialists to avoid confusion and allow more studies for more discussions in the literature.

Clip Myringoplasty.

Perforations of the tympanic membrane result mainly from otitis media or trauma, and we need grafting when a perforation is chronically persistent to prevent recurring infections and to enhance hearing. In the present study, we assessed the success rate, feasibility, and efficacy of endoscopic transcanal tympanoplasty using tragal cartilage grafts via the clip technique. This prospective study was performed between September 2017 and December 2021 and was conducted in ENT departments in tertiary hospitals. Forty patients underwent endoscopic clip technique tragal cartilage type 1 tympanoplasty. Patients with dry (for 3 months at least) small (less than 3 mm), medium (3-5 mm), or large (more than 5 mm) central perforations but not marginal perforations. TM perforation healing following the procedure for 6 months was achieved in 100% of the patients with small perforations, 18 of 19 (94.73%) with medium perforations and 11 of 12 (91.6%) with large perforations. At 6 months post-surgery, hearing improvement, as confirmed by audiometric results, was approximately 12.41 ± 1.01 dB. There was a highly significant improvement in the A-B gap (air-bone gap). Endoscopic chondro-perichondrial tragal graft with the clip technique for the repair of small-, medium-, and large-sized nonmarginal TM perforations is a minimally invasive, safe and effective technique compared with the conventional myringoplasty technique. It provided good results (closure of both the perforation and the air-bone gap), minimized morbidity, reduced the operative time, increased patient compliance, and reduced the duration of hospital admission.

A rare case report of hurthle cell adenoma mimicking malignancy

Thyroid lesions are the most common endocrine diseases, occurring in usually all age groups, though accurate diagnosis still remains a challenge, as due to oncocytic potentials of Thyroid cells leads to like indeterminate or suspicious diagnosis. Long standing benign Thyroid lesion shows atypical presentation suspicious to malignancy. Now a days with the help of WHO classification and available advanced diagnostic measures helping to confirm the diagnosis, avoiding overdiagnosis and wrong treatment. Hence this study review the importance of Histopathological study with coordination with immunohistochemistry (IHC) study, where suspicious thyroid malignant lesion finally diagnosed as benign Hurthle cell/ Oncocytic adenoma in Nodular Goitre.: 72 year old female presented huge neck swelling since one year, was reviewed in our departments of Pathology and ENT. Fine needle aspiration cytology (FNAC) features are suspicious of Malignancy, further Histopathological features were studied with co ordance of IHC study. FNAC features, which were suspicious of Malignancy were further studied with Histopathological and IHC studies diagnosed as Hurthle cell/ Oncocytic adenoma in Nodular Goitre. Histopathology remains the cornerstone for the diagnosis of thyroid oncocytic lesions and also in distinguishing between adenoma and carcinoma.

Dynamics of Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), and Platelet-to-Lymphocyte Ratio (PLR) in Patients with Deep Neck Infection

Background: Inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), have been utilized as prognostic factors in various diseases. This study aims to evaluate changes in the NLR, PLR, and LMR in patients diagnosed with a deep neck infections (DNI) to identify useful prognostic markers. Methods: This single-center, retrospective cohort study utilized data from the electronic medical records of patients admitted to the ENT department of a tertiary university hospital between January 2000 and August 2024. Patients diagnosed with a DNI during the study period were enrolled. Preoperative and postoperative inflammatory markers were measured in all patients, and NLR, LMR, and PLR values were calculated and analyzed. Results: The post-treatment NLR was significantly lower than the pre-treatment NLR. Similarly, the post-treatment LMR was significantly higher and the post-treatment PLR was significantly lower compared to pre-treatment values. Patients admitted to the ICU had higher inflammatory markers than those in general wards. Additionally, patients with elevated inflammatory markers had longer hospital stays. Inflammatory markers were also higher in older patients and those who underwent surgical treatment. Conclusions: Significant changes in the NLR, LMR, and PLR in patients diagnosed with a DNI can serve as useful prognostic markers. These findings suggest that monitoring these markers may help to assess and improve the inflammatory status of patients, highlighting their potential role in guiding treatment.

Result of consistent use of hearing aid in speech and language development.

Objective: To determine the benefits of proper guidance and proper use of hearing aid in language development age. Study Design: Descriptive Cross-sectional study. Setting: Department of ENT, Abbasi Shaheed Hospital and Karachi Medical and Dental College. Period: January 2022 to December 2023. Methods: In this study those cases were included which came with hearing loss. Both sexes were included in this study. After informed consent complete history and examination was done. Also relevant investigations were performed where required. Results: In this study, male were 72 (60%), male female ratio was 1.5:1. Highest number of patients were between the age of 6-8 years 60 (50%). Between 1.5 to 3 years, 51 children were properly guided and followed the proper instruction of use of hearing aid while 9 children were not properly guided and not properly used of hearing aid. 92 patients (76.6%) used hearing aid consistent with proper guidance, in which 79 (85.8%) children developed good speech and language. while 13 (14.1%) children were found poor in speech and language development while 28 (23.33%) children did not use hearing aid properly and all found poor in speech and language. Conclusion: Proper use of hearing aid which may be beneficial in improvement of word recognition and speech development in hearing impaired child under proper guidance and training from otologist and audiologist.

Comparison of Eosinophil Profile and Lund Kennedy Score in Patients with Nasal Polyps.

Nasal polyps are epithelial and stromal non-neoplastic proliferations of nasal cavity and paranasal sinuses. Nasal polyps are a consequence of damage in the epithelium of the nasal mucosa. Since eosinophils are the main inflammatory cells in the substantial proportion of nasal polyp tissues, they are considered potentially responsible for the etiopathogenesis and prognosis of the disease. This cross-sectional observational study was conducted in the department of ENT, H&NS, Government Medical College, Srinagar. A total of 62 patients were included in the study. The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). A total of 62 patients participated in the study. Majority of subjects were in the age group of 60-69 and the least number in 20-29. 47 patients had a mean lund kennedyscore of 13.34 ± 1.178 with peripheral eosinophil count of ≥ 500 and 15 patients had a score of 7.00 ± 0.632 with peripheral eosinophil count of < 500. 50 patients had a mean lund kennedy score of 13.04 ± 1.359 with tissue eosinophil count of ≥ 10/HPF and 12 patients had a score of 7.16 ± 0.669 with atissue eosinophil count of < 10/HPF. The conducted study indicates that the levels of tissue and peripheral osinophils are positively related to severity of nasal polyps as indicated by Lund Kennedy scores. Also, our study concluded that the disease has male preponderance.

Clinicopathological Profile in Patients with Tubercular Cervical Lymphadenitis and Its Treatment Outcome.

Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public.

A Study to Evaluate the Role of Probiotics in Allergic Rhinitis.

To compare treatment outcomes in allergic rhinitis patients with and without probiotics. The present study was conducted in the Out Patient Department of ENT in a Tertiary Care Hospital w.e.f. April 2023 till March 2024. Total 106 patients of allergic rhinits were included in the study and were divided randomly into 2 groups with 53 in each group. Group A was given probiotics along with standard treatment of antihistaminics and topical steroids and group B was given antihistaminics and topical steroids only. Total Nasal Symptoms Score (TNSS) of all patients was calculated at the time of enrollment and after 8 weeks post treatment. Based on the pre-treatment and post-treatment TNSS, an analysis was made whether probiotics could be an add-on therapy along with the standard treatment given for allergic rhinitis from past so many years. We conducted our study on 106 patients with mean age of 28.1 ± 8.91 years.44% were male and 56% were female. In group A pre-treatment TNSS was 8.057 + 2.307 and post treatment TNSS was 0.887 + 0.776. In group B pre-treatment TNSS was 9.45 + 0.514 and post treatment was 1.89 + 0.776. The mean post-treatment TNSS in group A was lower than the group B. This difference was statistically significant with p value of < 0.05. Based on the study we can suggest that probiotics could be a potential add-on strategy in the management of allergic rhinitis. Probiotic supplement action seems to be effective in ameliorating allergic rhinitis symptoms and improving the quality of life. However further clinical and molecular studies are required to improve our knowledge about interactions among candidate probiotics and host microbiome, cells and immune defenses, in order to create efficacious interventions.

Management of Giant Thyroid Tumors in Patients with Multiple Comorbidities in a Tertiary Head and Neck Surgery Center.

Background/Objectives: The thyroid gland can represent the seat of development for giant tumors exceeding 10 cm in diameter. A retrospective analysis on 21 cases of giant thyroid tumors with comorbidities, operated in the ENT Department of the Bucharest University Emergency Hospital has been conducted. Methods: Giant benign tumors accounted for 28.57% of the cases studied and reached gigantic volumes in an average time interval of 3 years, with an average resection piece weight of 318 g. Malignant tumors accounted for 71.43%, with an average duration of evolution of 7 years, with an average resection piece weight of 581 g. Results: Dysphagia was present in all patients, dyspnea in 47.61% and dysphonia in 38.09% of cases. Total thyroidectomy is the gold standard in giant thyroid tumors, associated with radical neck dissection, extended to groups VI and VII in malignant tumors. In 10 of 11 cases of giant malignant thyroid tumors (90.90%), without anaplastic thyroid carcinoma, the survival at 5 years after multimodal oncologic treatment was favorable. Anticoagulant treatment increased the risk of postoperative reversible recurrent laryngeal nerve lesion. Conclusions: The management of giant thyroid tumors in patients with multiple comorbidities needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, pathologist, ENT surgeon, thoracic surgeon, oncologist and radiotherapist.

Endoscopic Tympanoplasty in Chronic Otitis Media with Inactive Mucosal Disease

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Chronic otitis media (COM) is a condition usually seen in patients attending the ENT department. Chronic inactive mucosal disease (CIMD) is characterized by tympanic membrane (TM) perforation with hearing loss. Endoscopic tympanoplasty (ET) is a surgical method to repair TM perforation with minimal invasion. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; The present analysis was done to find out the outcome of ET surgeries in CIMD. &amp;lt;i&amp;gt;Methods:&amp;lt;/i&amp;gt; Retrospective data analysis was done in 30 patients underwent ET with endoscopic under-lay technique at Al-Ameen medical college, Vijapur, India. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; Average age of patients was 34.17±9.52 years. Majority (40%) patients were from 18-30 years of age group. There were 12 (40%) males and 18 (60%) females. Right-side and left-side CIMD was equally distributed in 30 patients. Sixteen (53.3%) and 14 (46.7%) patients were having right and left TM perforation, respectively. TM perforation size was small, medium and large in 43.3%, 30% and 26.7% of patients, respectively. Twenty-eight (93.3%) patients had temporalis fascia and 2 (6.7%) patients had tragal cartilage as graft material. Two (6.7%) patients had graft rejection without improvement in hearing. No patient had complication or any miscellaneous issues. Eighteen (60.0%), 11 (36.7%) and 1 (3.3%) pre-operative patient with pure-tone average (PTA) had mild, moderate, and severe conductive hearing loss (CHL), respectively. All patients with PTA were improved after surgery. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;ET is an effective, minimally invasive, and less painful surgical technique for repair of central TM perforations in CIMD.

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.

Role of reflux symptom index score in diagnosis of laryngopharyngeal reflux

Background: The retrograde flow of gastric contents to the upper aero digestive tract is known as laryngo pharyngeal reflux disease (LPRD). Diet and lifestyle play a huge role in the pathophysiology of LPR. Methods: A hospital based cross sectional study in the Department of ENT, KMCT, Kozhikode. 291 Patients were selected from those who presented to the OPD with throat symptoms who scored &gt;10 in a questionnaire (Reflux symptom Index) that was provided and were advised to undergo video laryngoscopy and their reflux finding score (RSI)was calculated. LPRD prevalence, RSI/Reflux Findings Score (RFS) correlations, and clinical/ laryngoscopic (video laryngoscopy) associations were analyzed. Results: LPRD prevalence was 68.7%, higher in females (60.1%) and the 41-50 age group (31.3%). Increased spicy food/caffeine intake and shorter dinner-bedtime intervals were significantly associated. Heartburn/indigestion was the most common symptom, with RSI mean 12.94±2.26. Erythema/hyperaemia was the most frequent laryngeal finding, with RFS mean 8.47±2.40. RSI and RFS scores significantly correlated. Conclusions: This study demonstrates a high LPRD prevalence among patients with throat symptoms, particularly in females aged 41-50 and influenced by dietary/lifestyle factors. RSI effectively identified LPRD in this resource-constrained setting, highlighting its diagnostic value. These findings provide valuable insights for managing and further investigating LPRD.