Orifice Of Eustachian Tube Research Articles

Radiofrequency Ablation Eustachian Tuboplasty for the Treatment of Chronic Otitis Media with Effusion and Premature Extrusion of the Tympanostomy Tube.

Objective: This study evaluated the effects of radiofrequency ablation (RFA) eustachian tuboplasty on the treatment of chronic otitis media with effusion (COME), and associated complications, in patients with premature extrusion of the tympanostomy tube (TT). Materials and Methods: Tuboplasty and T-tube reinsertion were performed in 23 ears with COME, a history of premature TT extrusion, and thickened mucus. Tube retention, perforation closure, hearing improvement, and complications were evaluated. Results: All 23 patients with COME and previous premature TT extrusion had remarkable mucosal hypertrophic disease or mucosal polypoid changes in the posterior cushion or posterior wall in the nasopharyngeal eustachian tube (ET) orifice. All surgeries were completed within 20 minutes after general anesthesia and were performed in the operating room. Pre-and post-air-bone gap gain was 18.3 ± 2.5 dB. The TT was retained for at least 12 months in 19 patients, whereas intentional premature removal at postoperative 8 to 9 months was required in 2 patients and premature extrusion occurred in 2 patients. Thus, the tube retention success rate was 91.3% (21/23). Of the 21 ears with intentional removal, the perforation closure rate was 81.0% (17/21). None of the patients reported RFA-related serious adverse events or a patulous ET. However, a scar synechia of the anterior-posterior wall was seen in 1 ET orifice, and stenosis of the ET orifice in 4 patients. Conclusions: RFA eustachian tuboplasty combined with TT insertion is a simple and minimally invasive technique for the treatment of intractable COME in patients with a thickened mucosa of the nasopharyngeal ET orifice. This technique may prevent premature TT extrusion.

First Investigation of a Eustachian Tube Stent in Experimentally Induced Eustachian Tube Dysfunction.

Unmet needs in the treatment of chronic otitis media and Eustachian tube dysfunction (ETD) triggered the development of stents for the Eustachian tube (ET). In this study, for the first time, stents were placed in an artificially blocked ET to evaluate stent function. Eight adult female sheep were injected with stabilized hyaluronic acid (HA) on both sides to induce ETD. Subsequently, a tapered nitinol ET stent was inserted on one side, and animals were examined bilaterally by endoscopy, tympanometry, cone beam computed tomography, and final histology. Seven of the stents were placed in the desired cartilaginous portion of the ET. At the end of the study, one stented side appeared slightly open; all other ET orifices were closed. Tympanometry revealed re-ventilation of the middle ear in four out of seven correctly stented animals within 3 to 6 weeks after stent insertion. The major amount of HA was found at the pharyngeal orifice of the ET anterior to the stent. Thus, the stent position did not completely align with the HA position. While a functional analysis will require refinement of the experimental setup, this study provides first promising results for stent insertion in a sheep model of ETD.

Intra-operative Measurement of Eustachian Tube Orifice, and Its Correlation With Post-operative Surgical Outcome in Chronic Suppurative Otitis Media Patients.

Background Chronic suppurative otitis media (CSOM) is the inflammation of the middle ear mucosa for more than two weeks, resulting in ear discharge. It is associated with hearing loss and the presence of a perforation in the tympanic membrane. Tympanoplasty is performed to place a graft and clear the disease in the middle ear. Despite adequate disease clearance and proper graft placement, graft failure and disease persistence occur due to Eustachian tube (ET) dysfunction. The ET plays a significant role in the ventilation of the middle ear. Hence, this study was conducted to determine the significance of ET size for post-operative graft uptake. Methodology A total of 55 patients with inactive CSOM were included in the study. Their demographic data were recorded. Patients previously operated on for CSOM, cases with traumatic perforation of the tympanic membrane, congenital anomalies (e.g., cleft lip/cleft palate), and atticoantral disease were excluded. Thorough history taking and examination, including otoscopy and examination of the nose, throat, and oropharynx, were conducted. Once the patient was deemed fit for surgery, they underwent tympanoplasty. Intraoperatively, the ET size was measured using the tip of the suction cannulas. They were followed up after three months to assess graft uptake. Results Out of 55 patients included in the study, 42 (76%) had good graft uptake, while 13 (24%) had defects in graft uptake. Graft uptake failed in patients with an ET diameter of <3 mm. Post-operative graft uptake was observed in the majority of patients with a wider ET diameter, ranging between 3 mm and 6 mm, with a statistically significant p-value of 0.00 (0.05), as determined by Pearson's Chi-square test. Conclusion In our study, we found that there is an association between the ET diameter and post-operative graft uptake. Hence, a wider ET may improve middle ear ventilation and play an important role in post-operative graft uptake.

The Optimal Head Position Following Intratympanic Injection: A Research Based on HRCT Reconstruction.

Objective: This study aimed to investigate the optimal head position (OHP) following intratympanic injection, a critical intervention in treating inner ear disorders. Identifying OHP is essential to maximize drug retention in the middle ear, thereby significantly enhancing the therapeutic efficacy by mitigating the significant issue of injectate leakage through the eustachian tube (ET). Exploratory various positions of ET orifice and round window (RW) were investigated and associated with head movements. Methods: Twenty-two (10 males and 12 females) anonymized high-resolution computed tomography (HRCT) datasets of patients without structural ear disease were selected from January 2022 to December 2022 in the study. The subjects were categorized into two groups: children (≤18 years) and adult group (>18 years). The reconstruction of the ET orifice and RW from HRCT were analyzed using Mimics software and the distances from the center point of ET orifice or the center point of RW to the reference plane were defined as distance of ET orifice (DET) and distance of RW (DRW). Results: In the supine position, the OHP for intratympanic injection was 23°of pronation and 24° of posterior extension, and the maximum distance between the ET orifice and RW (DET-RW) was 9.29 ± 2.13 mm. As the head position extended posteriorly beyond 43°, DET was relatively high compared with DRW, resulting in the OHP a fully posteriorly extended 90° of the head being the optimal position with DET-RW of 2.13 ± 1.60 mm in the supine position, however, it is not realized in human beings. Moreover, the OHP had no obvious relevance corresponding to age following intratympanic injections. Conclusion: Our study suggested that OHP after intratympanic injections treatment consists of supine position, along with a slight pronation and posterior extension.

Unveiling Nasopharyngeal Lipoma: A Case Study and Literature Review of Reported Cases

Lipoma is a benign tumor that typically affects middle-aged people and is rarely found in the oral cavity. Here, we report a 27-year-old female presented with a rare case of nasopharyngeal lipoma. She has been complaining of foreign body sensation in the throat, dysphagia, and attacks of obstructive sleep apnea for six months. On examination, nasopharyngeal mass was observed, which is originated from left eustachian tube orifice and extended to oropharynx, in contact with posterior surface of soft palate and uvula. CT revealed a well-defined capsulated lesion on the left side of lateral wall of nasopharynx which is emerging from left tonsil and measuring 17x18x20 mm. Histopathological examination confirmed the diagnosis of lipoma. Therefore, the mass was removed by surgical excision. Through a combined oral and endoscopic nasopharyngeal approach.

Endoscopic Evaluation after Conventional Adenoid Curettage.

Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.

Permanent occlusion of the Eustachian tube: a retrospective study on reopening procedures

PurposeThis study retrospectively evaluated the efficacy and versatility of reopening procedures for the permanent occlusion of the cartilaginous Eustachian tube (POET) by analyzing four consecutive cases.MethodsThe study included all patients diagnosed with POET who suffered from Eustachian tube occlusion and glue ear. A combined approach of endoscopic transnasal/transoral laser surgery was utilized to reopen the POET. This was subsequently followed by balloon dilation (BET) and stenting for a duration of six weeks. In one distinct case, the Eustachian tube orifice was approached via a transtympanic method, where a balloon catheter was placed. The primary outcome measures targeted the success rate of reopening, which was quantified using audiological outcomes and Eustachian tube patency verified by a positive Valsalva maneuver.ResultsFour patients, with an age range of 14–62 years (mean age of 29.3 years), were subject to Eustachian tube reopening. The duration of follow-up varied between 10 and 24 months, averaging at 16.2 months. Notably, 75% of the surgically treated ears displayed no evidence of glue ear upon their last follow-up and showed restoration of Eustachian tube patency. The procedures were executed without any surgical complications. The causes for POET in these patients were heterogeneous: two were attributed to scarring post adenoidectomy, one to occlusion following orthognathic surgery and the remaining one due to prior radiotherapy treatment for squamous cell carcinoma located at the soft palate.DiscussionTotal occlusion of the cartilaginous Eustachian tube may be linked to persistent middle ear diseases. It is imperative to conduct nasopharyngeal endoscopy in these cases. The findings from this study suggest that the Eustachian tube reopening procedure is predominantly effective and safe for patients with POET stemming from a variety of pathologies. Future research should focus on exploring advanced stenting devices and necessitate longer follow-up periods for comprehensive understanding.

Dissecting eustachian tube dysfunction: From phenotypes to endotypes.

A broad spectrum of complaints, symptoms and manifestations has been assigned to Eustachian tube (ET) dysfunction (ETD). While such presentations may manifest as ETD phenotypes, underlying mechanisms are defined as endotypes. Our goal is to develop a diagnostic approach to differentiate the endotypes and guide clinicians in the workup and selection of treatments targeting the mechanism of ETD. Retrospective. Tertiary care. Children and adults with suspected ETD were evaluated with a thorough examination, otomicroscopy, otoendoscopy, trans-nasal videoendoscopy and testing of passive and active ET dilatory properties. Degree of weakness in soft palate elevation and ET orifice widening (muscular weakness, ETD-M), presence of inflammation (ETD-I) and/or adenoid tissue impinging and restricting the ET opening (ETD-R) were assessed with video-endoscopy. The Forced Response Test, Inflation-Deflation Test and Pressure Chamber Test were used as applicable to quantify the degree and type of difficulty (Stricture, ETD-S or adhesive, ETD-A) or ease (patulous or semi-patulous, ETD-P/SP) in opening the ET, and degree of active muscular strength/weakness (ETD-M) was measured. Ears with normal function (ETF-N) findings were also identified. Video-endoscopic and ETF test results were obtained for 71 ears of 40 subjects (22 males, 18 females; 38 white, 2 black), with an average age of 22.9 ± 16.5 years (min:6.2, max:64.1). Videoendoscopy (21, 13, 33, 16, 13, 0, 0 ETs) and ETF testing analysis (20, 24, 0, 38, 0, 3, 13 ears) were categorized as ETF-N and the ETD endotypes ETD-S, ETD-R, ETD-M, ETD-I, ETD-A, and ETD-P/SP, respectively. Some phenotypes had features consistent with more than one endotype. A systematic approach of examination and testing may differentiate the specific underlying mechanisms, lead to a treatment targeted to the ETD endotype and may establish novel ways to diagnose and treat ETD.

Case Report: Eustachian Tube Dysfunction after Penetrating Facial Trauma.

Traumatic conductive hearing loss (TCHL) is most commonly attributed to tympanic membrane perforations, hemotympanum, or ossicular chain disruption. These complications are generally managed conservatively for up to 6 months with good hearing outcomes. We encountered a case of penetrating facial trauma leading to TCHL because of obstructive Eustachian tube dysfunction (OETD), which is not a previously described etiology for OETD and TCHL. A lysis of scar tissue surrounding the Eustachian tube with balloon dilation was performed in our patient, resulting in resolution of conductive hearing loss. In the absence of traditional signs of TCHL, providers should consider OETD as a potential cause of TCHL. We recommend visualization of the Eustachian tube orifice and balloon dilation if clinically indicated.

이관질환의 치료

The patients with Eustachian tube disorder could complain of various symptoms, such as earfullness, tinnitus, hearing disturbance, otalgia, or autophony. It is important to accurately diagnose the disease and choose appropriate treatment method to prevent further complaints or complications from the disorder. For all types of Eustachian tube dysfunction, conservative therapy should be the first choice, especially when duration of the symptom is short or transient. Even if the symptoms do not improve and persist, surgical therapy could be considered. For the dilatory Eustachian tube dysfunction, surgical therapy includes ventilation tube insertion, adenoidectomy, and balloon Eustachian tuboplasty. For the patulous eustachian tube dysfunction, there are various surgical methods: ventilation tube insertion, mass loading on the tympanic membrane, invasive Eustachian tuboplasty, injection to nasopharyngeal Eustachian tube orifice, trans-tympanic or trans-nasal catheter insertion, and trans-tympanic silicone plug insertion. It is important to select the appropriate treatment methods according to the degree of improvement of symptoms.

반복된 삼출성 중이염 환자에서 발견된 이관 지방종 1예

In the case of unilateral recurrent otitis media with effusion in adults, endoscopic examination of the nasopharyngeal tumor is necessary. Rarely, tumors can also develop in the eustachian tube. The incidence of lipoma in the eustachian tube is very rare. Lipomas are benign tumors arising from mesenchymal tissue and composed of well-differentiated adipocytes. A 49-year-old female patient visited for nasal congestion. But she had history of repetitive ventilation tube insertion due to recurrent otitis media with effusion. A yellowish round mass was noted at left eustachian tube orifice under nasal endoscopic exam. It was removed through intranasal access using sinus endoscopy. About 1 year after the surgery, there were no recurrence of tumor and middle ear effusion.

Reconstruction of the Obliterated Eustachian Tube: A Pilot Case Series.

To investigate the safety and early efficacy of a procedure for reconstruction of the obliterated Eustachian tube (ET). Retrospective case series. Patients with total obliteration of the cartilaginous ET, with intractable mucoid effusion causing repeated occlusion of tympanostomy tubes were included. Patients underwent endoscopic transnasal/transoral reconstruction of the obliterated ET using transtympanic illuminated guidewire guidance. A temporary stent (angiocatheter filled with bonewax) was placed to maintain patency while healing. In four cases an additional steroid-eluting propel stent was placed in the ET orifice. Main outcome measures were otomicroscopy results, absence of middle ear effusion, and nasopharyngoscopy showing patency of the ET orifice. Nine ETs (seven patients), ages 17-68 years (mean 37.9) underwent ET reconstruction. Follow-up ranged from 4 to 56 months (mean 30.9 months). 89% of operated ears had no effusion at last follow-up. Two patients (three Eustachian tubes) underwent successful reoperation. There were no complications directly related to the procedure. Etiologies of obliteration included scarring after sinus surgery, obstruction after maxillo-mandibular advancement surgery (two patients), bullous pemphigus, gunshot trauma, and previous patulous obliteration (two patients). Complete occlusion of the cartilaginous ET can be associated with intractable mucoid effusion; endoscopic examination should be considered in such cases. In this pilot study, ET reconstruction was found to be a safe and possibly effective procedure in patients with total obliteration of the ET from various etiologies. Larger studies with long term follow up are indicated. 4 Laryngoscope, 133:1970-1975, 2023.

Nasopharyngeal morphology contributes to understanding the "muddle in the middle" of the Pleistocene hominin fossil record.

The late archeologist Glynn Isaac first applied the term "muddle in the middle" to a poorly understood period in the Middle Pleistocene human fossil record. This study uses the nasopharyngeal boundaries as a source of traits that may inform this unclear period of human evolution. The nasopharynx lies at the nexus of several vital physiological systems, yet relatively little is known about its importance in human evolution. We analyzed a geographically diverse contemporary Homo sapiens growth series (n= 180 adults, 237 nonadults), Homo neanderthalensis (La Chapelle aux Saints 1, La Ferrassie 1, Forbes Quarry 1, Monte Circeo 1, and Saccopastore 1), mid-Pleistocene Homo (Atapuerca 5, Kabwe 1, Petralona 1, and Steinheim 1), and two Homo erectus sensu lato (KNM-ER 3733 and Sangiran 17). Methods include traditional (Analysis 1) and 3D geometric morphometric analysis (Analysis 2). H. erectus exhibited tall, narrow nasopharyngeal shape, a robust, ancestral morphology. Kabwe 1 and Petralona 1 plotted among H. sapiens in Analysis 2, exhibiting relatively shorter and vertical cartilaginous Eustachian tubes and vertical medial pterygoid plates. Atapuerca 5 and Steinheim 1 exhibited horizontal vomeral orientation similar to H. neanderthalensis, indicating greater relative soft palate length and anteroposterior nasopharynx expansion. They may exhibit synapomorphies with H. neanderthalensis, supporting the accretionary hypothesis. Species-level differences were found among H. sapiens and H. neanderthalensis, including relatively longer dilator tubae muscles and extreme facial airorhynchy among Neanderthals. Furthermore, H. neanderthalensis were autapomorphic in exhibiting horizontal pterygoid plate orientation similar to human infants, suggesting that they may have had inferiorly low placement of the torus tubarius and Eustachian tube orifice on the lateral nasopharyngeal wall in life. This study supports use of osseous nasopharyngeal boundaries both for morphological characters and understanding evolution of otitis media susceptibility in living humans.

Endoscopic closure of the Eustachian tube orifice for refractory lateral skull base cerebrospinal fluid leak using autologous fat graft: illustrative case.

BACKGROUNDRhinorrhea due to lateral skull base cerebrospinal fluid (CSF) leaks can be a challenge to manage. Multiple strategies exist for treating CSF leaks in this region including direct repair, posterior Eustachian tube packing, and CSF diversion. Endonasal closure of the Eustachian tube has been reported using cerclage and mucosal flaps.OBSERVATIONSWe present the first reported case of endoscopic autologous fat packing of the Eustachian tube orifice to repair a CSF leak. In this case a 42-year-old woman who underwent middle fossa meningioma resection 20 years ago presented with refractory CSF rhinorrhea despite blind sac closure of the ear canal. This persisted after CSF diversion and only resolved after endoscopic endonasal Eustachian tube closure described herein.LESSONSThis technique is simple to perform with minimal risk of morbidity. Eustachian tube orifice fat packing may be particularly useful for patients with refractory CSF rhinorrhea with low CSF pressure.

The cranial base and related internal anatomical features in Homo neanderthalensis and Homo sapiens.

The cranial anatomy of Homo neanderthalensis and Homo sapiens is well documented in the paleoanthropological and medical literature. However, there are few high-quality visual guides of their comparative morphology. We give here a detailed description of the anatomy of two important fossil specimens, La Chapelle-aux-Saints 1 and abri Pataud 1, based on high-resolution imaging data with each specimen representing the respective morphologies of H. neanderthalensis and H. sapiens. We describe the comparative morphology of external, endocranial, and internal characteristics of the cranium, with a focus on the petrous and tympanic portions of the temporal bone. This descriptive approach shows differences between our specimens, including in positions of cerebral components relative to cranial structures and patterns of dural sinus drainage. Numerous external and internal differences in the shape of the petrous temporal are also described, including its articulation with the tympanic bone and the orientation of the petrotympanic crest. The presence of a large protuberance between the osseous Eustachian tube orifice and carotid foramen in H. neanderthalensis suggests that the levator veli palatini muscle took origin more laterally than the dilator tubae arm of the tensor veli palatini muscle, a feature shared with H. sapiens. The overall pattern that emerges is one in which two species have undergone large-scale evolutionary changes in a functionally critical region. Such differences necessitate high-quality visualization and consideration of both internal and external morphology.

Classification, diagnosis and treatment of Eustachian tube dysfunction literature review

&lt;b&gt; Introduction:&lt;/b&gt; The Eustachian tube (ET) is the anatomical structure that connects the middle ear with the nasopharynx. It is part of a system that, in addition to the already mentioned elements, also includes the soft palate. The functions of ET are pressure equalization, clearance of secretions and protection of the middle ear from sounds and reflux of secretions from the nasopharynx. Dysfunctions of ET are multifactorial, and the diagnostics is difficult due to lack of defined standards for assessing its function prior and post treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of the study is the review of the publications concerning actual definitions and classification of ET dysfunctions, efforts of adopting unified criteria and methods of assessing its functions and ways of treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Material and methods:&lt;/b&gt; In the year 2015 classification was adopted which distinguish three subtypes of ET dysfunction: (1) dilatory ET dysfunction, (2) baro-challenge-induced, (3) patulous ET. Dilatory ET dysfunctions were further divided as follows: functional obstruction (most common), dynamic dysfunction and anatomical obstruction. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) enables the systematization of symptoms. Clinical assessment of the patient with ET dysfunction should include otoscopy or otomicroscopy, tympanometry, Rinnes and Webers tuning fork tests or pure tone audiometry, nasopharyngoscopy with visualization of ET orifice and opening. Other tests of assessment of ET functions like tubomanometry, sonotubomanometry and pressure chamber tests are useful research tools. Endoscopic evaluation of ET orifice should encompass the assessment of mucosa of the torus tubarius and ET as well as dynamic process of ET opening. In surgical treatment of functional obstructions of ET, the most common method is balloon dilatation tuboplasty. Several studies showed that this is safe and in high percentage of cases successful method of treatment, however the indications for this type of surgery are not yet universally accepted.

Comparison of Electrocoagulation Tuboplasty and Continued Medical Therapy for Treating Persistent Eustachian Tube Dysfunction With Hypertrophic Mucosa Disease

The objective of this trial was to compare outcomes of electrocoagulation tuboplasty and continued medical therapy for treating persistent Eustachian tube dysfunction (ETD) with hypertrophic mucosa disease in the Eustachian tube (ET) orifice. Prospective, case-control trial. Patients with persistent ETD were recruited and allocated to electrocoagulation tuboplasty and continued medical therapy groups. The ETD questionnaire-7 (ETDQ-7) score and objective parameters were compared between the groups at 6 and 12 months. The proportion of patients with a decrease in ETDQ-7 scores was greater in the electrocoagulation group than in the medical therapy group at the 6-month follow-up (53.49% and 34.38%, respectively; p = .158), but the difference was not statistically significant. However, at the 12-month follow-up, there was a significantly higher proportion of patients with a decrease in ETDQ-7 scores in the electrocoagulation group (88.37% and 40.63%, respectively; p = .001). Additionally, a significant difference was observed between the groups in terms of the proportion of patients who improved 12 months after the treatment (tympanometry: 72.09% and 9.38%, respectively; p = .001; air-bone gap: 79.07% and 25.00%, respectively; p = .001; tympanic membrane status: 62.79% and 0.00%, respectively). In addition, the proportion of patients with improvements in the ET inflammation score was significantly different between the groups at 6-month (67.44% and 34.38%, respectively; p = .009) and 12-month (93.02% and 34.38%; p = .001) follow-ups. No device- or procedure-related serious adverse events were reported in any patients. Electrocoagulation Eustachian tuboplasty appears to be a safe and feasible procedure for adult persistent ETD with hypertrophic mucosa disease in the ET orifice, and is superior to continued medical management alone. The improvements in ETDQ-7 and objective parameters persisted for 12 months.

Middle ear squamous cell carcinoma: a case report

&lt;p class="abstract"&gt;Squamous cell carcinoma of middle ear is a rare entity. We present a case of 77 year old male, with squamous cell carcinoma of middle ear. Patient presented with blood tinged otorrhoea. Oto-endoscopy examination revealed a soft tissue lesion in middle ear which bled on touch. Histopathological study of this soft tissue lesion gave a diagnosis of well differentiated squamous cell carcinoma. Radical clearance of the tumour achieved after removal of the malleus and incus. Tumour was seen extending into the eustachian tube orifice and it was removed in toto. Uderlying bone was ablated using diode laser to confirm the radical clearance. Later patient was given radiotherapy 6 weeks after surgery to allow the healing of the operative site. The objective to report this case was to emphasize the importance of early diagnosis and prompt treatment for a better survival. Long standing history of ear discharge with soft tissue lesion bleeding on touch should always be evaluated by histopathological study to exclude malignancy.&lt;/p&gt;

Demographic profile of subjects currently undergoing middle meatus antrostomy for maxillary sinusitis, in a tertiary care centre of Punjab: analysis of 64 subjects

Background: The demographic profile of patients with Maxillary sinusitis undergoing surgical intervention in the state of Punjab was analyzed. The emphasis was on the age, gender and clinical presentation in this prospective study. Methods: In this prospective study 64 patients with maxillary sinusitis, were randomly selected from the Rhinology clinics of Oto-rhino-laryngology services, Dayanand Medical College and Hospital, Ludhiana in a period of one and a half years (June 2008 to December 2009). All patients were taken up for Functional endoscopic sinus surgery with middle meatus antrostomy.Results: Only 7 (10.94%) patients, with maxillary sinusitis were in the pediatric age group. 40(62.5%) were males and 24 (37.5%) females. Males outnumbered females in the ratio of 1.67:1. Clinical findings were nasal polyp in 33 (51.56%), middle meatus discharge in 10 (15.63%) and septal deviation was seen in 36 (56.25%) patients. Polypoidal mass was seen in the posterior choana in 24 (37.5%) patients followed by discharge inferior to the Eustachian tube orifice in 7 (10.94%). Recurrence of polypoidal change or frank polyposis occurred in 7 patients (10.94%). Post nasal drip persisted in 15/49 cases, while 54 (84.38%) were completely relieved of their symptoms. Recurrence was noticed more commonly in the region of ethmoid air cells.Conclusions: Patients with maxillary sinusitis were seen in the broad age range from 11 to 66 years with a male predominance. Nasal blockage rather than cheek ache was the primary complaint followed by polyp in the middle meatus and post nasal drip inferior to the Eustachian tube.

Demographic profile of subjects currently undergoing frontal sinusotomy for frontal sinusitis, in a tertiary health care facility of Punjab

Background: The demographic profile of patients with frontal sinusitis undergoing surgical intervention in the state of Punjab was analysed. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: In this prospective study 85 patients of clinically diagnosed frontal sinusitis were randomly selected from the Rhinology clinics of Oto-rhino-laryngology services, Dayanand Medical College and Hospital Ludhiana; in a period of one and a half years (June 2008 to December 2009). All patients were taken up for functional endoscopic sinus surgery with frontal sinusotomy.Results: 3 (3.53%) subjects, with frontal sinusitis were in the pediatric age group, 65 (76.47%) were males 20 (23.53%) females. Males outnumbered females by a ratio of 3.25:1. The age range varied from a minimum of 8 to a maximum of 86 years. 16 (18.8%) had a discharge in the right middle meatus and 21 (24.7%) over the Eustachian tube orifice. Right sided deviation of the nasal septum was in 13 (14.1%) patients, septal spur in 4 (4.7%) and hypertrophy of the inferior turbinate in 7 (8.2%).Conclusions: Frontal sinusitis was seen in all ages with a male predominance. Nasal blockage on the right side rather than frank frontal headache was the primary complaint. Purulent discharge in the middle meatus and over the Eustachian type were the common findings. Pathology on histopathology encountered was mucosal hypertrophy followed by polyp in the sinus. There was no correlation of frontal sinusitis with the weight and height of the patients