Head And Neck Surgery Research Articles

Brush Cytology on Pre-Malignant and Malignant Oral Lesions with Histopathological correlation

Introduction: Oral cancer is the sixth most common malignancy worldwide and accounts for 30% of all cancers in India, with 5-year survival rate, except when diagnosed in the early stages. Hence, early diagnosis of oral cancer is very much essential for the sake of the patient. However its burden on the economy for providinghealthcare is substantial and with the increasing incidence of oral cancer in developing countries like India and the other South-East-Asian countries, the role of screening methodologies for early detection of pre – cancerous and cancerous lesions of oral cavity are becoming more vital
 Methodology: An observational cross-sectional study conducted in the departments of Otolaryngology & head neck surgery in close association with department of Pathology in a tertiary based teaching institute in North Bengal, India, during April 2021 to March 2022. All the patients aged above 18 years, who visited the outpatient department of Otolaryngology & Head Neck Surgery, and admitted in the ward of the same, having oral lesions which are clinically suspected as pre- malignant and malignant lesions were included in this study.
 Results: The study population comprised of total 69 cases. Among them 47 cases (~68%) were malignantlesions, 13 (~19%) cases were pre-malignant and 9 (~13%) cases were diagnosed as benign lesions consideringHistopathology result. 30 (63.8%) out of 47 malignant cases show class-5 cytological grading in brush cytology smear, stained with Pap stain. 25.5% of the malignant cases were in class-4 and 10.6% cases were in class-3 whereas, in premalignant cases (n=13), 3 cases were in class-2 and 7 cases were in class-3 and 3 were in class-1. Maximum value of AgNOR counts for benign, pre malignant and malignant lesions were 3.54, 4.16, 7.28 respectively.
 Conclusion: The brush cytology with PAP grading and AgNOR analysis in clinically suspected oral lesionscan be used as an early diagnostic tool for diagnosing oral squamous cell carcinoma especially for lower socio-economic status people who present with late stages.

Gender distribution and women leadership in German Otolaryngology, Head and Neck Surgery.

To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology-Head and Neck Surgery (OHNS) departments. This cross-sectional study collected data about the physician workforce in the German OHNS.The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership. We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536-7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001). Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality-supporting policies. IV.

Cost analysis of face-to-face visits, virtual visits, and a digital care pathway in the treatment of tonsillitis patients

PurposeThe aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. MethodsWe characterized and analyzed the patient flows and their individual episodes of all tonsillitis patients at the Department of ORL-HNS between September 2020 and August 2022. Records were collected by doctors at the clinic. We investigated costs and allocated resources in four categories: invoice from the Department of ORL-HNS to the public payer, expenses to the Department, patient fees, and doctor's resource. ResultsAt least a third of the tonsillitis patients were eligible for telemedicine. The digital care pathway was 12.6 % less expensive for the public payer compared to the previous virtual visit model. For the Department, the expense of the digital care pathway was 58.8 % less per patient than the virtual visit model. Patient fees decreased 79.5 %. The digital care pathway reduced the doctor's resource from 30.28 min to 19.78 min, which accounts for a 34.7 % reduction. Patients finished the digital care pathway in a median of 62 min (SD = 60) compared to the 2–4 h which they would spend on an outpatient clinic visit. ConclusionOur study demonstrates that tonsillitis patients are eligible for preoperative telemedicine. With at least a third of the tonsillitis patients being eligible for telemedicine, major cost savings can be achieved with efficient e-health-assisted solutions.

The Association between Papillary Thyroid Carcinoma and Thyroid Stimulating Hormone (TSH)

Background: The results of thyroid-stimulating hormone (TSH) and thyroid hormones on the improvement of human Papillary thyroid cancer (PTC) stay poorly understood. TSH is an increase component that stimulates thyroid tissue to produce thyroid hormone; additionally, it influences the increase of thyroid cells and thyroid cancers cells. Objectives: The aim of this study is to assess the Association between Papillary Thyroid Carcinoma and Thyroid Stimulating Hormone (TSH). Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Otolaryngology &amp; Head-Neck Surgery, TMSS Medical College, Bogura, Bangladesh and Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh. The duration of the period from March 2019 to February 2020. Data was entered in MS Excel and Statistical analysis was done using SPSS trial version. Results: This study indicates that in accordance to age distribution of 70 Patients. Here in accordance to Age distribution, 3(4.28%) have been &lt;30, 11(15.72%) have been 30-39, 14(20%) have been 40-49, 15(21.43%) had been 50-59, 21(30%) had been 60-69 and 6(8.57%) had been ≥70. And in accordance to gender (14.28%) had been Male, (85.72%) have been Female. Conclusion: We found a significantly extended threat of PTC related with TSH levels under the ordinary range amongst women and with TSH tiers above the normal range amongst men.

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery.

This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized. Cross-sectional study. Tertiary referral hospital. A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports. Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A. Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.

Patients with Laryngeal Disorders Who Undergone Microlaryngeal Surgery at The Dr. Soetomo General Hospital Surabaya

Objective: To describe laryngeal abnormalities undergoing microlaryngeal surgery (MLS). Material and Methods: A retrospective analytical study by examining the central medical record and electronic medical record of patients with laryngeal disorders in the otorhinolaryngology head and neck surgery (ORL-HNS) Outpatient Unit and the Teratai ORL-HNS Surgery Inpatient Care Unit at Dr. Soetomo General Hospital, Surabaya, from January 1 until December 31, 2019, utilizing the chi-square test followed by the Wald test. Results: The number of patient visits from January 1 until December 31, 2019, amounted to 80 patients, most of whom were male and belonged to the 19-60 age group. The histopathology results of patients with neoplasms indicated moderately differentiated squamous cell carcinoma, while the same procedure applied to patients without neoplasms mainly indicated vocal nodules. In this case, the most used technique was a biopsy. Patients with smoking risk factors amounted to 38, while those without smoking risk factors amounted to 42. Conclusion: MLS is used as a means of diagnosis and therapy, including cases of benign and malignant neoplasms.

Local therapy of acute otitis media in children

Acute otitis media (AOM), one of the most common infectious and inflammatory diseases in infants, toddlers and young children, is defined as an infectious inflammation of the middle ear, usually bacterial, often with earache, fever, and possibly otorrhea. Almost all children suffer from otitis media, 80–90% – at preschool age. The frequency of acute otitis media in children in a megapolis is more than 4 000 cases per 100 000 population, however, given the large proportion of asymptomatic variants against the background of acute respiratory infections, insufficient equipment of pediatricians with otoscopes, registration of acute otitis media almost exclusively by ENT doctors, the frequency of acute otitis media may be significantly higher. The clinical picture may be nonspecific. Ear pain and otoscopy are decisive for the diagnosis. The severity of inflammation correlates well with the scale of visual assessment of pain according to the child’s facial expressions. The aims of treatment are to relieve pain using topical or systemic analgesics, decide together with an ENT specialist on the need for antibiotic therapy, avoid not indicated antibiotic therapy, prevent complications (tympanic membrane perforation, acute mastoiditis, meningitis). With unexpressed otitis media, it is advisable to use symptomatic therapy and drops. A complex of compounds (lidocaine, phenazone) provides a quick therapeutic effect. Topical anaesthetics block the transmission of the pain signal from the receptor to the central nervous system through the inhibition of voltage-gated sodium channels. The symptomatic treatment (analgesics, antipyretics, topical therapy) results in improvement in 60% of patients within the next 24 hours, and in 80% within the next 3 days.For prophylaxis of otitis, it is necessary to prevent acute respiratory infections, do vaccination against influenza and pneumococcal infections, avoid exposure to tobacco smoke, and keep babies breastfeeding.

Analysis of allergopathology test results as a way to improve the quality of work of an otolaryngologist

The article analyzes the importance of conducting diagnostic studies in the practice of an ENT doctor. The purpose of the study: to analyze the effectiveness of modern algorithms for allergy diagnostics using molecular genetic methods and their importance for an ENT doctor.

Frequency of Regional Metastasis in Supraglottic Carcinoma of Larynx

Background: Incidence of laryngeal cancer still high among the upper aerodigestive tract. 85–95% of these laryngeal cancer is squamous cell carcinoma. Locally advanced laryngeal cancer metastasize more. Supraglottic cancers have the highest prevalence of regional metastases among laryngeal cancers.&#x0D; Objectives: To evaluate the frequency of regional metastasis in supraglottic carcinoma of larynx.&#x0D; Methods: This cross-sectional study was conducted including 40 patients with supraglottic Carcinoma of Larynx over a period of six months from June to November 2014 in the ENT and Head Neck Surgery department of Rajshahi Medical College Hospital, Rajshahi. Those with glottic carcinoma, subglottic carcinoma, hypopharyngeal carcinoma, metastatic neck node without any primary site (Occult primary) were excluded from the study. FNAC from neck node was done in patients with palpable neck node.&#x0D; Results: Most of the patients 19 (47.5%) was in age group 50-60 years with mean age 54.5±13.2 years. Most of the patients present with more than one symptom &amp; the commonest presenting symptoms was cough and irritation 35(87.5%) followed by dysphagia 26(65%) and change of voice 24(60%). A good number of patients, 16(40%) was presented with neck swelling. Among 40 patients, 16(40%) had their regional lymph nodes involved. Level-II lymph nodes were involved in higher number of cases 10(62.5%). Nodes in early stage of involvement were found in most cases 9(56.5%). Homolateral involvement of nodes was found in most cases 13(81.3%).Most of the supraglottic growths 22(55.0%) was exophytic in appearance. The common site of supraglottic carcinoma in this study was aryepiglottic fold and arytenoids 20(50.0%). Among the patients, 31(77.5%) had T2 tumours. Amon them, 16(40%) were in stage-III followed by stage-II 10(25%).&#x0D; Conclusion: Regional metastasis is a very useful prognostic indicator. Supraglottis is rich in lymphatic drainage and a high proportion of these tumors spread to lymph nodes.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 180-185

RESULTS OF AUDIOMETRICAL INDICATORS OF COCHLEVESTIBULAR DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION DISEASE

In this article, the authors present the audiological description of cochleovestibular disorders against the background of arterial hypertension and the analysis of examination results. According to world statistics, more than 460 million people worldwide had hearing loss in 2019, and by 2050, their number may exceed 900 million. According to a number of foreign authors, complaints characteristic of cochleovestibular disorders (CVD) make up about 10% of patients who consult an ENT doctor, and for a general practitioner, this figure is 5%, and for a neurologist, 10-20%. Dizziness is one of the three most common complaints presented by patients to their general practitioner, occurring in 2.4-2.6% of patients during emergency consultations.

Support of deep learning to classify vocal fold images in flexible laryngoscopy

PurposeTo collect a dataset with adequate laryngoscopy images and identify the appearance of vocal folds and their lesions in flexible laryngoscopy images by objective deep learning models. MethodsWe adopted a number of novel deep learning models to train and classify 4549 flexible laryngoscopy images as no vocal fold, normal vocal folds, and abnormal vocal folds. This could help these models recognize vocal folds and their lesions within these images. Ultimately, we made a comparison between the results of the state-of-the-art deep learning models, and another comparison of the results between the computer-aided classification system and ENT doctors. ResultsThis study exhibited the performance of the deep learning models by evaluating laryngoscopy images collected from 876 patients. The efficiency of the Xception model was higher and steadier than almost the rest of the models. The accuracy of no vocal fold, normal vocal folds, and vocal fold abnormalities on this model were 98.90 %, 97.36 %, and 96.26 %, respectively. Compared to our ENT doctors, the Xception model produced better results than a junior doctor and was near an expert. ConclusionOur results show that current deep learning models can classify vocal fold images well and effectively assist physicians in vocal fold identification and classification of normal or abnormal vocal folds.

Generation of synthetic tympanic membrane images: Development, human validation, and clinical implications of synthetic data.

Synthetic clinical images could augment real medical image datasets, a novel approach in otolaryngology-head and neck surgery (OHNS). Our objective was to develop a generative adversarial network (GAN) for tympanic membrane images and to validate the quality of synthetic images with human reviewers. Our model was developed using a state-of-the-art GAN architecture, StyleGAN2-ADA. The network was trained on intraoperative high-definition (HD) endoscopic images of tympanic membranes collected from pediatric patients undergoing myringotomy with possible tympanostomy tube placement. A human validation survey was administered to a cohort of OHNS and pediatrics trainees at our institution. The primary measure of model quality was the Frechet Inception Distance (FID), a metric comparing the distribution of generated images with the distribution of real images. The measures used for human reviewer validation were the sensitivity, specificity, and area under the curve (AUC) for humans' ability to discern synthetic from real images. Our dataset comprised 202 images. The best GAN was trained at 512x512 image resolution with a FID of 47.0. The progression of images through training showed stepwise "learning" of the anatomic features of a tympanic membrane. The validation survey was taken by 65 persons who reviewed 925 images. Human reviewers demonstrated a sensitivity of 66%, specificity of 73%, and AUC of 0.69 for the detection of synthetic images. In summary, we successfully developed a GAN to produce synthetic tympanic membrane images and validated this with human reviewers. These images could be used to bolster real datasets with various pathologies and develop more robust deep learning models such as those used for diagnostic predictions from otoscopic images. However, caution should be exercised with the use of synthetic data given issues regarding data diversity and performance validation. Any model trained using synthetic data will require robust external validation to ensure validity and generalizability.

Simulation en dermatologie 1 : consultation d’annonce d’un mélanome

To collect a dataset with adequate laryngoscopy images and identify the appearance of vocal folds and their lesions in flexible laryngoscopy images by objective deep learning models.We adopted a number of novel deep learning models to train and classify 4549 flexible laryngoscopy images as no vocal fold, normal vocal folds, and abnormal vocal folds. This could help these models recognize vocal folds and their lesions within these images. Ultimately, we made a comparison between the results of the state-of-the-art deep learning models, and another comparison of the results between the computer-aided classification system and ENT doctors.This study exhibited the performance of the deep learning models by evaluating laryngoscopy images collected from 876 patients. The efficiency of the Xception model was higher and steadier than almost the rest of the models. The accuracy of no vocal fold, normal vocal folds, and vocal fold abnormalities on this model were 98.90 %, 97.36 %, and 96.26 %, respectively. Compared to our ENT doctors, the Xception model produced better results than a junior doctor and was near an expert.Our results show that current deep learning models can classify vocal fold images well and effectively assist physicians in vocal fold identification and classification of normal or abnormal vocal folds.

Social Media Utilization in Otolaryngology: A Scoping Review.

Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable. A scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen. 171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n=37 [21%]), and within subspecialties of otology (n=38 [22%]) and rhinology/allergy (n=25 [15%]). Facebook was most frequently used for study recruitment (n=23 [13.5%]), YouTube for patient education (n=15 [14.6%]), and Twitter for professional networking (n=16 [9.4%]). SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 2023.

Intersectionality of Race, Ethnicity, and Gender in the Otolaryngology Match From 2013 to 2019.

Racial, ethnic, and gender disparities in the otolaryngology-head and neck surgery (OHNS) match have been described individually, but not intersectionally. Intersectionality recognizes how multiple forms of discrimination (e.g., sexism, racism) can have a combined effect. The objective of this study was to analyze racial, ethnic, and gender disparities in the OHNS match using an intersectional approach. Cross-sectional evaluation of data from otolaryngology applicants from the Electronic Residency Application Service (ERAS) and of corresponding otolaryngology residents from the Accreditation Council for Graduate Medical Education (ACGME) from 2013 to 2019. Data were stratified by race, ethnicity, and gender. The Cochran-Armitage tests assessed trends over time in the proportions of applicants and corresponding residents. Chi-square tests with Yates' continuity correction were performed to evaluate differences between the aggregate proportions of applicants and corresponding residents. The proportion of White men in the resident pool was increased compared to the applicant pool (ACGME 0.417, ERAS 0.375; Δ + 0.042; 95% CI 0.012 to 0.071; p= 0.03). This was also the case for White women (ACGME 0.206, ERAS 0.175; Δ + 0.031; 95% CI 0.007 to 0.055; p= 0.05). In contrast, there was a smaller proportion of residents compared to applicants among Multiracial men (ACGME 0.014, ERAS 0.047; Δ - 0.033; 95% CI -0.043 to -0.023; p< 0.001) and Multiracial women (ACGME 0.010, ERAS 0.026; Δ - 0.016; 95% CI -0.024 to -0.008; p <0.001). The findings of this study imply that White men have a persistent advantage, while several racial, ethnic, and gender minorities are disadvantaged in the OHNS match. Further research is necessary to examine why these differences exist in residency selection, including evaluation during the screening, reviewing, interviewing, and ranking stages. Laryngoscope, 133:2558-2563, 2023.

Foreign Body Ingestion in an Adult not Associated with Mental Disorder: An Unusual Clinical Case Report

Introduction and objective: Esophagus is a muscular and mucosal tubular organ with 4 physiological narrowing’s that are preferred sites for the retention of foreign bodies accidentally or deliberately ingested. The latter form is frequent in people with mental disorders and prisoners. The aim of this study is to describe a rare clinical case of foreign body ingestion.Case Report: This case describes an incident in which a young man deliberately swallowed a key to hide evidence of theft. This is a unique case in the literature of deliberate ingestion in mentally healthy people and not part of the prison population. Discussion: Foreign bodies are a public health problem, related with huge ENT doctor's activities. It represents the first cause of ENT emergency services care. Although large foreign body ingestion is rare. The worldwide literature is full of articles related with little accidental foreign bodies ingestion, especially in children, such as coins, toys, fish bones and bones Conclusions: In the presence of intentionally and/or accidental foreign bodies ingested in adults, it is necessary to discard mental disorders or social factors.

Developing Consensus on Priority Pediatric Otolaryngology-Head and Neck Surgery Conditions and Procedures.

The aim of this study was to develop an international expert consensus on priority pediatric otolaryngology-head and necksurgery (OHNS) conditions and procedures for which all national health systems globally should be capable of managing. The Delphi method is a multiround online questionnaire and was administered internationally to otolaryngologists with a focus on pediatric populations. This study was administered in parallel to a Delphi survey focusing on adult OHNS conditions amongst adult otolaryngology experts. International online survey. In round 1, participants listed the top 15 pediatric otolaryngological conditions and top 15 pediatric otolaryngology procedures for their World Bank region. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as at least 70% of the round 2 Likert responses being ranked as either "important" or "very important." Descriptive statistics were calculated for each round. The survey was distributed to 35 experts globally, with a 40% (n = 14) response rate. Fifty percent (n = 7) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. A list of 28 consensus surgical procedures and 11 consensus conditions were identified. This Delphi survey method of world experts in pediatric otolaryngology identified a core list of medical conditions and surgical procedures that should be a part of every national health system's clinical goals of treatment, research, and capacity building.

Hearing Outcomes of Stapedotomy In Patients With Otosclerosis

Objective: This study was focused on the assessment of patient’s improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis. Materials and Methods: This prospective clinical study was performed in a total of 156 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT &amp; Head-Neck Surgery, Combined Military Hospital Dhaka between January 2013 to January 2019. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction &amp; air conduction thresholds and the Air-Bone gap (ABG), were documented and analyzed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 83.97% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except 03, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 04 patients developed post-op severe vertigo which was self-limiting after six weeks. 01 patient developed transient facial weakness which was subsided over a time period of 03 months. Patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy. Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes. J Dhaka Med Coll. 2021; 30(2) : 156-160

Pattern of Neck Node Metastases In Laryngeal Carcinoma

Background: Cancer continues to be a major health problem despite advances in medical technology for its diagnosis and treatment. Cancer of the larynx is the eleventh most common cancer in the world. Carcinoma larynx is a multifactorial disease. Smoking, betel-nut, betel-leaf chewing habit and drinking alcohol are the most important factors associated with carcinoma larynx. Objective: To find out the patterns of neck node metastases in laryngeal carcinoma. Methods: Observational cross-sectional study was carried out in the Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital (DMCH) from January’ 2018 to December’ 2019. Total 100 patients diagnosed as laryngeal carcinoma with neck metastases were included in this study. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: The mean age was found 57.8±12.7 years with range from 37 to 79 years. Males were predominant (76.0%) and females were (24.0%). Male: female ratio was 3.17:1. More than two third (68.0%) patients had supraglottis, 26.0% had glottis and 6.0% had subglottis. Supraglottic was found in 68 patients among them 27(39.7%) were T3, 18(26.5%) were T3. Glottic was found in 26 patients among them 16(61.5%) were T3, 6(23.1%) were T2, 4(15.4%) were T4a. Subglottic was found in 6 patients among them 4(66.7%) were T3 and 2(33.3%) was T2. Supraglottic was found in 68 patients among them 34(50.0%) were N1, 28(41.1%) were N2 and 6(8.8%) were N3. Glottic was found in 26 patients among them 20(76.9%) were N1 and 6(23.1%) were N2. Subglottic was found in 6 patients among them 4(66.7%) were N1 and 2(33.3%) was N2. supraglottic was found in 68 patients, among them majority 17(50.0%) patients were found in level II of neck nodes. Glottis was found in 26 patients, among them 16(61.5%) patients were found in level III of neck nodes. Subglottic found in 6 patients, among them 4(66.7%) patient was found in level IV of neck nodes. Unilateral neck node metastasis was more common 9(96.0%) than bilateral neck node metastasis 4(4.0%), out of them single neck node metastasis 84(84.0%) is more than multiple neck node metastasis 16(16.0%). Majority 46(46.0%) patients had stage III, 38(38.0%) had stage II, 10(10.0%) had stage I and 6(6.0%) had stage IV. Conclusion: Laryngeal carcinoma is a common clinical entity in otolaryngology practice. Male were more predominant and the highest age group was 51-60 years. Common clinical presentation was difficulty in swallowing and hoarseness of voice. In this study most common Laryngeal carcinoma was supraglottic in nature and majority of them were in level II. N1 was the most common pattern of neck node metastasis. Most of the neck nodes are unilateral and single. Stage III was the commonest stage of involvement. J Dhaka Med Coll. 2021; 29(1): 52-60

Aerobic Microorganisms in Nonspecific Neck Abscess - A Prospective Study in A Tertiary Level Hospital

Background: The knowledge of the local pattern of infection and microorganisms in non-specific neck abscess is essential to enable efficacious treatment for it. Objective: To find out the pattern of bacteria responsible for developing non-specific neck abscess and to analyze the coverage rate of different empiric antimicrobial agents. Materials and methods: It is prospective observational type of study carried out into Department of Otolaryngology &amp; Head Neck Surgery, Dhaka Medical College Hospital, Dhaka and Department of Clinical Microbiology, ICDDR,B, Dhaka from1st January,2016 to 30th June, 2016. Total 100(Hundred) patients were included in this study. Data were analyzed using computer based programmed statistical package for social science (SPSS). Results: This study was done among 100 patients. In this study 42 cases (42%) were in the (31- 45) years age group. The male patients were 60 (60%) and female were 40 (40%). Majority of patients 70(70%) came from poor class family with 70 (70%) patients came from rural area, 50 (50%) patients had dental infection, 40(40%) patients were smoker, 35 (35%) patients had diabetes mellitus, all the cases (100%) presented with dysphagia and fever. The major complication was necrotizing fasciitis 8 (8%), common space was sub mandibular space (45%), Streptococcus 30 (30%) was the most common organism. Conclusion: The most frequently isolated organism in neck abscess is Streptococcus. J Dhaka Med Coll. 2021; 29(1): 31-37