Throat Department Research Articles

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.

Silent Sinus Syndrome: A Paediatric Condition Diagnosed in the Orthodontic Department

Silent sinus syndrome (SSS) is defined as unilateral maxillary sinus hypoplasia and orbital floor resorption. This case report highlights a rare paediatric diagnosis of SSS during an orthodontic clinic. The diagnostic orthopantogram (OPG) and cone-beam computed tomography showed complete opacification of the left maxillary sinus. Following referral to the ear, nose and throat (ENT) department, a CT sinus confirmed SSS. Owing to the risk of facial asymmetry in a growing adolescent patient without surgical intervention, functional endoscopic sinus surgery will be used to manage this. This case highlights the importance of a thorough investigation of incidental findings. CPD/Clinical Relevance: The clinical relevance of early diagnosis of silent sinus syndrome and its implications on facial symmetry is discussed.

The Antimicrobial Effect of Silver Nanoparticles on some Fungi isolated from Otitis Media

This study involved the inhibitory effect of silver nanoparticles with plant extracts against the fungi isolates from otitis media evaluated. A total of 216 samples were collected from individuals suffering from otitis media with age ranging from 1-70 years, who visited the Ear Nose and Throat (ENT) Department at Al-Hawija General Hospital between September 2022 and March 2023.The results of culture on Sabouraud dextrose agar media showed microbial infection in otitis media in 114 samples, accounting for 52.77% of the cases. Regarding fungi, Candida spp. was the predominant species, found in 81 samples, representing 37.5%. Plant extracts demonstrated high efficiency in inhibiting fungi. The alcoholic extract of the Callistemon viminalis plant exhibited the highest inhibitory effectiveness with an average inhibition zone diameter of 16.19mm followed by the aqueous extract of the Callistemon viminalis plant with an average inhibition zone diameter of 15.44 mm. Silver nanoparticles showed inhibitory effects on the studied fungal isolates. The silver nanoparticles manufactured from the Callistemon viminalis plant exhibited the highest inhibitory effect with an average inhibition zone diameter of 17.52mm against Candida parapsilosis yeast.

Socioeconomic Inequality in the Head and Neck Cancer Referral System: Redressing the Balance.

Socioeconomic deprivation is a known risk factor for head and neck cancer (HNC). Despite this, there is no current way to acknowledge this in two-week wait (2WW) referrals. 2WW HNC referrals have continually risen, and a self-reporting questionnaire was trialled with referrals to the ear, nose and throat (ENT) department with suspected HNC, allowing additional triage information not included in referrals to be obtained. Patients referred through the 2WW pathway for HNC between February 2021 and March 2022 were asked to complete an electronic self-reporting symptom questionnaire. The vetting process resulted in the referral being accepted or regraded to less urgent referral streams. Scottish Index of Multiple Deprivation (SIMD) quintiles were derived using the online postcode checker tool. A total of 984 2WW referrals were retrospectively reviewed. The questionnaire was completed by 717 (72.9%) patients. Regrading of urgency resulted in 292 (29.7%) 2WW appointments not required. Of those regraded, 264 (90.4%) patients completed the questionnaire. A significantly greater number of patients (p = 0.03) from SIMD 4 and SIMD 5 were regraded (33.3%) compared to SIMD 1 and SIMD 2 (26.4%). Patients who did not complete the questionnaire had a higher median age (61.0 years, range: 17-96, IQR: 25.0) compared to those who completed the questionnaire (56.0 years, range: 17-88, IQR: 23.5, p < 0.001). A self-reported symptom questionnaire can help rebalance urgent appointments to those with genuine red flag symptoms. This in turn reduces social inequality in 2WW referrals and reduces the number of inappropriate 2WW appointments.

The effect of glucoregulation on hearing loss in patients with diabetes mellitus type 2

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; Hyperglycemia causes the well-known microvascular complications of diabetes mellitus (DM) such as diabetic retinopathy, polyneuropathy and nephropathy, but it can also affect the inner ear, and hearing loss (HL) can be considered as one of the microvascular complications. The aim of the study was to evaluate association between HL and values of glycated hemoglobin A1c (HbA1c) in patients with diabetes mellitus type 2 (DMT2).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods. &amp;lt;/strong&amp;gt;In this retrospective-observational cross sectional study, we included 80 patients divided into two groups: experimental group consisting of 40 patients with DMT2 and control group consisting of 40 patients who were not previously diagnosed with DM. Data were retrieved from electronic medical records of patients treated in outpatient clinic of the Ear, Nose and Throat Department, University clinical center of Republic of Srpska (UCC RS) from 2023 to 2024.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results. &amp;lt;/strong&amp;gt;Out of 40 patients from experimental group, 15 were males (37.5%) and 25 were females (62.5%). Regarding glycoregulation patterns in experimental group, patients were stratified into three subgroups: HbA1c &amp;amp;lt; 7% (N 17; 42.5%), HbA1c-9% (N 17; 42.5%) and HbA1c &amp;amp;gt; 9% (N 6; 15%). In the experimental group, a significant (p&amp;amp;lt;0.000) greater number of patients had HL, and significant greater number of patients had bilateral HL (N 32; 80%, p&amp;amp;lt;0.05) with predominantly pronounced sensorineural HL (N 36; 90%, p&amp;amp;lt;0.05).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;Patients with DMT2 had a higher incidence of HL compared to controls. The sensorineural type of HL showed a significantly high prevalence among patients with DMT2. HbA1c levels may be a potentially significant predictor of HL in DMT2.&amp;lt;/p&amp;gt;

Ultrasonography-Guided Fine Needle Aspiration Cytology Versus Histopathology: Diagnostic Consistency in Salivary Gland Neoplasms.

Introduction Salivary gland lesions include a diverse range of histological types and biological behaviors, making accurate diagnosis and effective treatment challenging for specialists. Fine needle aspiration cytology (FNAC) plays a significant role in making preoperative diagnoses and further plans of surgery. In differentiating malignant from benign salivary gland tumors, the diagnostic accuracy of fine needle aspiration cytology (FNAC) is high. However, the final diagnosis is histopathological. The aim of this study is to correlate cytological and histopathological interpretations in salivary gland lesions. Materials and method Thirty patients were included in this study, all of them were diagnosed with salivary gland swellings and operated on in the ear, nose, and throat (ENT) department of Mata Gujri Memorial (MGM) Medical College, Kishanganj, in the northeastern region of India, between December 2020 and November 2022. Ultrasonography (USG) and computed tomography (CT) scans were performed in each case, and FNAC was done to make a preoperative diagnosis. After surgery, specimens were collected for histopathological examination. A correlation was then made between the findings of the preoperative cytological examination and the results of the postoperative histopathological examination. The comparison was performed using a 2×2 table, and the analysis of sensitivity, specificity, positive predictive value(PPV), and negative predictive value (NPV) was carried out using Microsoft Excel (MicrosoftCorp., Redmond, WA) and SPSS software (IBM SPSS Statistics, Armonk, NY). Results An equal number of male and female samples were included in the study, in which parotid involvement was predominant (60%). On FNAC, 53% of parotid gland tumors were found to be benign, whereas only 23.3% of submandibular gland tumors were benign. Pleomorphic adenoma was the most common finding. In the present study, the sensitivity, specificity, positive predictive value, and negative predictive value of USG-guided FNAC, compared to the gold standard histopathology, were 96%, 33.3%, 92.3%, and 50%, respectively. The diagnostic accuracy was found to be 89.3%. Conclusion The findings of this study suggest that FNAC is a reliable technique for the preoperative diagnosis of salivary gland tumors, as it is minimally invasive and offers valuable diagnostic information. An accurate cytological diagnosis can help avoid unnecessary surgery.

WP6.1 - A survey of the estimated cost of surgical consumable items within Ear, Nose, Throat departments

Abstract Aims Studies suggest that practitioners lack knowledge on cost of consumables and fail to appreciate the financial consequences of waste. We aimed to investigate this claim amongst ENT practitioners. Methods An online questionnaire, requiring cost estimations for 20 consumable items, was distributed to London ENT departments. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price. Results 10.65% of all estimations were ‘correct’. There was no correlation between job role and cost-estimation accuracy. The most accurately estimated item was ‘fenestrated sterile drape’ (24.4%), the least was ‘1L bag of IV normal saline’ and ‘package of sterile sponges’ (0%). Conclusions We found poor cost appreciation of consumables amongst ENT surgeons. This could serve as a catalyst for the inclusion of health economics in specialty training curricula, improving cost-awareness.

Cephalometric differences in grades II and IV adenoid hypertrophy: A cross-sectional study.

This study aims to determine whether there were cephalometric changes between grades II and IV adenoid hypertrophy. A cross-sectional study was conducted on 120 6-12-year-old patients selected from the ear, nose, and throat department at Imam Al-Hussein Medical City in Karbala. Patients were classified into three groups (each = 40) based on endoscopic findings: control, grade II, and grade IV. The findings were confirmed with cephalometric radiographs. Specific cephalometric points were identified to measure sella-nasion-point A (SNA), sella-nasion-point B (SNB), point A-nasion-point B (ANB), sella-nasion-pogonion (SNPog), sella nasion plane-palatal plane (SNPP), palatal plane-mandibular plane (PPMP), sella nasion plane-mandibular plane (SNMP), saddle, articular, gonial angles, and the y-axis. Additionally, superior-posterior airway space (SPAS), posterior air way space (PAS), mandibular plane-hyoid bone (MP-H), third cervical vertebra-hyoid bone (C3-H), total anterior facial height (TAFH), total posterior facial height (TPFH), upper anterior facial height (UAFH), lower anterior facial height (LAFH), and the Jarabak ratio were measured. Analysis of variance (ANOVA) and Welch tests indicated statistically significant differences (P < 0.05) among the three groups in SNA, SNB, SNPog, PPMP, SNMP, gonial angle, y-axis, SPAS, PAS, MP-H, and the Jarabak ratio. Tukey's honestly significant difference (HSD) and Games-Howell tests indicated a statistically significant difference between grade II and grade IV in SNA, SNMP, y-axis, SPAS, PAS, MP-H, and Jarabak ratio. The present study demonstrated that craniofacial changes start to occur at the moderate adenoid enlargement throughout the downward backward mandibular rotation. More changes would become evident at the severe stage; therefore, an urgent medical intervention and the establishment of nasal breathing by orthodontic treatment with breathing activity would be needed.

Oroantral Fistula Reconstruction by Pedicled Buccal Pad of Fat adjuvant with Advancement Flap (Clinical Study)

Aim: As well as highlighting the role of buccal fat of pad in closure large defects by evaluating healing process through pain, swelling and wound healing scores. Material and Method: A prospective evaluation study was conducted among patients who underwent surgical closure to OAC in both Ear Nose and Throat Department with the Maxillofacial Department of Al-Salam Teaching Hospital in Mosul City of Nineveh Province. Data recorded includes demographical Information and clinical evaluations. Two operators measured the parameters. Pain and swelling assessment through the visual analogue scale (VAS) assess the level of pain on the third, seventh and day twenty following surgery. Wound Evaluation Scale used to evaluate closure of the oroantral communication without nasal regurgitation at 1st week (day 7) and 20th days post- surgery and measure the surgical success. Results: The highest age group are between (20-29 years) with percent (56.5). male show high incidence (56.5%) more than female (43.47). In regard to cause extraction followed by tumors are the common cause for oroantral fistula (56.5%, 17.39). Day three and seven reflect different ranges of pain with highest percent for severe pain in day three (65.21%) and reduced to slight pain (82.60%) in day seven. In regard to swelling, in day three most of cases show very severe swelling (73.91%). In day seven the cases represent sever swelling (78.26%). Twenty-one patients from total 23 show incomplete healing at day seven while two patients have uncertain healing. In day 20 just one patient shows incomplete healing process. Conclusion: Buccal pad of fat can be used safely as adjuvant to buccal advancement flap for closure and is efficient in management of OAC to avoid diminished soft tissue in different size cases. Pain, swelling scales can be used as assessment for healing process added to them soft tissue wound healing scale.

Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy: A case report

BACKGROUND Primary nasal tuberculosis (TB) is a rare form of extrapulmonary TB, particularly in patients receiving anti-tumor necrosis factor (TNF) immunotherapy. As a result, its diagnosis remains challenging. CASE SUMMARY A 58-year-old male patient presented to the ear, nose, and throat department with right-sided nasal obstruction and bloody discharge for 1 month. He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation. Biopsy findings revealed chronic granulomatous inflammation and a few acid-fast bacilli, suggestive of primary nasal TB. He was referred to our TB management department for treatment with oral anti-TB agents. After 9 months, the nasal lesions had disappeared. No recurrence was noted during follow-up. CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate, particularly when pathological findings suggest granulomatous inflammation.

Demographic and clinical characteristics of our patients diagnosed with laryngeal dystonia

PurposeLaryngeal dystonia (LD) is a focal dystonia affecting laryngeal musculature with no known etiology or cure. The present study evaluated the sociodemographic and clinical features of patients diagnosed with LD.Materials and MethodsAll patients diagnosed with LD at our University Hospital’s Ear, Nose, and Throat Department between January 2017 and July 2023 were retrospectively analyzed. The study included 43 patients.ResultsOut of the 43 patients, 19 (44%) were male. At the time of diagnosis, the mean age of the patients was 35.1 years (ranging from 17 to 65 years). The mean elapsed time between the first symptom onset and the first diagnosis was 49.2 months (min. 4 months, max. 240 months). Of the participants, 94% had adductor-type LD. None of the patients had a family history of LD. Of the patients, 9 (20%) experienced a life-altering event or trauma just before the onset of symptoms. All patients who consumed alcohol reported symptom relief with alcohol intake. A total of 67.6% of patients stated that their symptoms were triggered by stress. All of our patients received at least one Botulinum toxin injection, with an average of 2.75 dosages per patient.ConclusionThe gender distribution was approximately equitable between males and females. There was a tendency for men to receive a diagnosis earlier than women following the manifestation of symptoms. A significant number of patients associate the emergence of their symptoms with a stressful event or traumatic experience. This study represents the initial investigation into the sociodemographic characteristics of patients within the Turkish population.

Evaluation of sinonasal involvement in patients with asthma and chronic obstructive pulmonary disease.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are the most common obstructive diseases. Based on the similarities, we aimed to evaluate sinonasal symptoms in patients with asthma or COPD, and compare the two diseases with regard to upper-airway involvement. Methods: Patients with asthma or with COPD who were followed up at Ankara University Immunology and Allergy or Chest Diseases Departments were included in the study. The participants went through pulmonary function tests, skin-prick tests, and disease severity assessment of either disease. Nasal endoscopic evaluations of all the patients were performed in the Department of Otorhinolaryngology. Lund-Mackay scoring was performed on the computed tomography of the paranasal sinus. Chronic rinosinusitis (CRS) diagnosis was made as recent guidelines. Results: A total of 112 subjects (number of women/men: n = 67/45; median age, 49 years [The range for IQR was 22 years]) were included in the study. Fifty-five patients had asthma, 33 had COPD, and 24 were healthy controls. Nasal symptoms were more frequent in the patients with asthma (patients with asthma, n = 52 [98%]; patients with COPD, n = 17 [52%]; controls, n = 9 [38%]) (p < 0.001). The median (IQR) 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire score was higher in the patients with asthma (33 [20-50]) than in the patients with COPD (8 [1.5-18.7]) and the control group (3.5 [0-18.7]) (p < 0.01). Patients with asthma had significantly higher prevalence rates of rhinosinusitis than did those in the COPD and the control groups (36%, 15.6%, 8.3%, respectively; p < 0.01). The SNOT-22 optimal cutoff score was calculated as ≥11 to detect the score limit for CRS prediction with the best sensitivity and specificity. Conclusion: As a result, patients with both asthma and COPD may have upper-airway symptoms. CRS, was primarily seen in the patients with asthma. Accordingly, SNOT-22 scores were higher in the patients with asthma than in those in the COPD and the control groups. A referral to the Ear Nose Throat department for further evaluation with nasal endoscopy and computed tomography of the paranasal may be required in a subgroup of patients.

Management Challenges And Outcome Of Juvenile Onset Respiratory Papillomatosis In A Tertiary Hospital In North Central Nigeria: A Preliminary Study

Background/Aim: Juvenile Onset Recurrent Respiratory Papillomatosis (JoRRP) is a benign tumour attributed to human papillomavirus infection with a high propensity to recur despite appropriate treatment. It is relatively rare but the commonest benign tumour of the larynx in children. This study is aimed at evaluating its management challenges.&#x0D; Materials and methods: This was a retrospective review of patients with JoRRP at Ear, Nose and Throat (ENT) Department, University of Ilorin Teaching Hospital over a 7-year period. The patients' biodata, mode of presentations, surgical care, histopathological findings and management outcome were reviewed.&#x0D; Results: A total number of ten patients were diagnosed with JoRRP during the study period. Male to female ratio was 1:1. All the children were delivered per vaginal and sixty percent were first children of their mothers. Hoarseness, breathy voice and worsening difficulty in breathing were the presentation in 7 (70%) of cases, while 3 (30%) presented with only hoarseness and breathy voice. They all presented first to General Practitioners and Paediatricians before ENT Specialist assessment and six (60%) patients presented to ENT department 6 months or more after the onset of symptoms. They all had direct laryngoscopy and excisional biopsy of laryngeal papillomatous lesions. Thirty percent had tracheostomy done. There is a statistical significant relationship between tracheostomy rate and recurrence rate of JoRRP.&#x0D; Conclusion: JoRRP is a rare but potentially life-threatening benign tumor of the respiratory tract. Most of our patients presented late and were misdiagnosed at presentation. The key to good management outcome remains early diagnosis, adequate management and regular follow-up.

Association of Body Mass Index with Neck Circumference and Snoring in Adult Patients with Hypertrophic Tonsils

Objective: We aimed to determine association of Body mass index (BMI) with neck circumference and snoring in patients with hypertrophic tonsils. Study Design: Cross-sectional research. Settings: Ear Nose and Throat Department of a tertiary care hospital situated in Karachi Pakistan. Duration: January to July 2021. Methods: It was a cross-sectional research and non-probability consecutive sampling technique was utilized for data collection. A written informed consent was obtained by each enrolled participant following by recording of data by filling subject valuation proforma. Detailed history of participants and anthropometric data was noted followed by grading of tonsils during oral examination. The study was conducted at Otorhinolaryngology department of PNS Shifa hospital from January to July 2021.Data was entered and analyzed using SPSS 23.0 software. Results: The current study enrolled adult subjects (n=54) with hypertrophic tonsils between 18-60 years with mean age of 25.72 ± 7.9 SD. There were 29 (54%) males and 25(46%) females. There were 31(57%) subjects with normal BMI, 14(26%) overweight and 9 (17%) obese subjects. There were 24(44%) snorers and 30(55.5%) non-snorers. Regarding neck circumference 1(3%) male had neck circumference ≥42 cm whereas 28(97%) had neck circumference ≤ 37.5 cm. Statistically significant association was observed when compared BMI and snorers p-value 0.001, whereas regarding neck circumference significant association with BMI was observed in females (p-value 0.0001) as compared to males (p-value 0.310). Conclusion: Snoring was associated with raised BMI whereas increased neck circumference in females was seen to be associated with raised BMI as compared to male individuals. It is important to consider these anthropometric measurements when assessing patients with obstructive sleep apnea.

Current Rehabilitative Concepts in Ear Nose and Throat Department, University of Medical Sciences Teaching Hospital (UNIMEDTH): Challenges Encountered

Introduction: Unaddressed communication disorders are multidimensional, affecting individuals physiologically, psychologically and emotionally. The quality of life of these individuals can be improved with rehabilitative measures, justifying this study. The study therefore aims to assess the impact of rehabilitation on these patients, determine the challenges and proffer possible solutions. Methods: Eighteen months prospective study on audiological and speech disorders among ENT patients in the University of Medical Sciences Teaching Hospital, Ondo State, from April 2021 to September 2022 was carried out. History was taken, general examination and full E.N.T. examinations were done. Those with audiological disorders from canal blockage due to foreign bodies, debris and impacted wax had ear syringing. Others with persistent audiological condition were further evaluated and treated accordingly, with Hearing Aids trial and fitting inclusive. Patients with speech disorder had speech therapy after baseline audiological screening. Data were represented in tables and figures. P value &lt; 0.05 was statistically significant. Results: 930 patients presented at the ENT clinic. 537 (57.74%) females and 393 (42.26%) males. Of this, 405 (43.55%) patients had audiological conditions while 23 (2.47%) had speech disorders. Impacted wax, tinnitus, hearing loss, foreign body in the ear and delayed speech development were commonest. 297 had syringing while 105 patients were further evaluated. 369 of 405 patients were successfully rehabilitated. 3 stroke patients had good speech recovery. Predominant challenges encountered were unavailability of instruments and uncooperativeness of elderly patients. Weekly savings and incorporation of dedicated relatives for home therapy ensures solutions respectively. Conclusion: Rehabilitation in E.N.T., though gradually progressive, is beneficial. The guiding concept is patience.

Oncocytic papillary cystadenoma of the larynx: a case report

BackgroundCystadenoma of the salivary glands is a rare benign clinical condition affecting both major and minor salivary glands equally. It constitutes approximately 2% of total neoplasms and 4.2–4.7% of benign formations in minor salivary glands. Typically presenting as a slow-growing, painless neoplasm, it can be distinguished from Cystadenolymphoma (Whartin’s Tumor) by the absence of lymphoid elements in histological examination. While mostly located in the oral cavity and oropharynx, it can also be found in sinonasal mucosa, and rare cases have been identified in the larynx.Case presentationA 75-year-old Caucasian woman presented to the ear, nose, and throat department with complaints of dysphonia and headaches persisting for several months. Dysphonia had developed months after an unspecified vocal cord surgery elsewhere. Flexible laryngoscopy identified a left-sided cystic swelling affecting the supraglottic space, leading to respiratory obstruction and dysphonia. Head and neck computed tomography confirmed a 1.9 × 1.7 cm bilobed cystic mass originating from the left Morgagni ventricle. Microlaryngoscopy with CO2 laser excision and biopsy revealed a histopathological diagnosis of oncocytic papillary cystadenoma. Post-surgery, the patient fully recovered from dysphonia, with no significant complications noted. Long-term clinical surveillance was advised to detect potential recurrences promptly.ConclusionEctopic minor salivary gland tumors, both benign and malignant, should be taken into consideration as potential differential diagnosis for any swelling arising within the upper digestive tract mucosa. Ears, nose, and throat clinical examination completed by videolaryngoscopy can easily point out the location of the mass. Imaging is mandatory for differential diagnosis and for surgical planning. Surgical excision can provide both diagnosis and definitive cure.

Clinical features and Surgical Outcomes of Thyroid Goitre Presenting to Ear, Nose and Throat Department of Queen Elizabeth Central Hospital, Blantyre, Malawi.

In Malawi there is a perception that goitre is common and causes significant public health and economic burdens. The purpose of this study was to assess the demographic distribution, clinical presentation, investigations, management, outcomes and complications of goitre seen at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A single hospital-based descriptive retrospective study from January 2017 to December 2018 for all patients presenting with goitre. Out of 9073 patients who presented to ENT department, 105 patients presented with goitre representing 1% of all patients seen during the study period. The Male: Female ratio was 1:25. The mean symptom duration with goitre was 4 years (SD +/- 6.4). Thyroid function test results were available in 54 patients and out of these, 53(98%) patients were euthyroid. Ultrasound scan (USS) reports were available in 44 patients, of these 32(73%) were multinodular goitres. In 70 cases, pathology results were available and showed that 20% were thyroid cancers and that papillary thyroid carcinoma was the commonest cancer (64%). Two recurrent laryngeal nerve injuries were recorded in 79 surgical procedures representing 2.5% of patients (6.3% overall complication rate). Inpatient stay ranged from 2 days to 49 days (median 3 days). Goitre at our centre is more common in women than in men. One in five patients in this cohort had thyroid cancers. This prevalence is higher than other areas in the world highlighting the need for cytology services on every patient before surgery and histology services after surgery. Recurrent laryngeal nerve injury and other complications were infrequent demonstrating local high safety of thyroid surgery, despite late presentation to the ENT department.

Lentiviral expression of wild-type LAMA3A restores cell adhesion in airway basal cells from children with epidermolysis bullosa

The hallmark of epidermolysis bullosa (EB) is fragile attachment of epithelia due to genetic variants in cell adhesion genes. We describe 16 EB patients treated in the Ear, Nose and Throat department of a tertiary pediatric hospital linked to the United Kingdom’s National EB unit between 1992 and 2023. Patients suffered a high degree of morbidity and mortality from laryngotracheal stenosis. Variants in laminin subunit alpha-3 (LAMA3) were found in 10/15 patients where genotype was available. LAMA3 encodes a subunit of the laminin-332 heterotrimeric extracellular matrix protein complex and is expressed by airway epithelial basal stem cells. We investigated the benefit of restoring wildtype LAMA3 expression in primary EB patient-derived basal cell cultures. EB basal cells demonstrated weak adhesion to cell culture substrates, but could otherwise be expanded similarly to non-EB basal cells. In vitro lentiviral overexpression of LAMA3A in EB basal cells enabled them to differentiate in air-liquid interface cultures, producing cilia with normal ciliary beat frequency. Moreover, transduction restored cell adhesion to levels comparable to a non-EB donor culture. These data provide proof-of-concept for a combined cell and gene therapy approach to treat airway disease in LAMA3-affected EB.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Awareness of First-Aid Management of Epistaxis Among Individuals in Al-Ahsa Region.

Introduction Epistaxis is among the most common emergencies in the Ear, Nose, and Throat department. The vast majority of these patients are treated with basic first-aid management. Our study aims to assess the awareness of first‑aid management of epistaxis among individuals in the Al-Ahsa region, Kingdom of Saudi Arabia. Materials and methods This is a cross-sectional study conducted among the male and female population in Al-Ahsa, Saudi Arabia, during March 2023, and it included all participants available at the time of the study. All the data were obtained using an online questionnaire. Results The study included 385 participants; 213 (55.3%) were females and 172 (44.7%) were males. Based on the correlation between our variables, 235 (61%) of the participants had a good awareness scorewhile only 150 (39%) had a poor score. Our findings show that 113 (65.7%) of males had a good level of awareness and 122 (57.3%) of females had a good level of awareness regarding epistaxis. Participants who had gone through an experience of the treatment of any patients with epistaxis had better awareness about first-aid management of epistaxis than participants who had never gone through the experience. Conclusion The knowledge and awareness regarding first-aid management of epistaxis among the general population was satisfactory. However, we should increase the level of knowledge of individuals who did not treat any people with epistaxis because there are many cases of epistaxis in Al-Ahsa However, more integrated educational materials should be available to the general population to improve their overall knowledge. Social campaigns in public areas will enhance the level of knowledge regarding epistaxis management among the general population.