An International Journal of Otorhinolaryngology Clinics

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2021 | May-August | Volume 13 | Issue 2

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Editors’ Speak

Bachi T Hathiram, Vicky S Khattar

Reader's Special

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/aijoc-13-2-vi  |  Open Access |  How to cite  | 



Reshma P Chavan, Shivraj M Ingole, Ajay P Damodhar, Gajanan S Kanchewad

Hearing Assessment in Infants with Otoacoustic Emission and Auditory Brainstem Response: A Retrospective Study

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:5] [Pages No:29 - 33]

Keywords: Brainstem-evoked response audiometry, Hearing assessment, Hearing loss, High-risk infants, Newborn, Otoacoustic emission

   DOI: 10.5005/jp-journals-10003-1382  |  Open Access |  How to cite  | 


Aim and objective: An attempt was made to find hearing status in all high-risk infants and no risk infants with the help of otoacoustic emission (OAE) and auditory brainstem response (ABR). Materials and methods: A retrospective study of hearing assessments of 330 infants was done with OAE and ABR from August 2019 to February 2020 at tertiary hospital. Various details of all participants such as age, sex, high-risk factors, detailed history of the current disease, maternal history during pregnancy, and complications during delivery were recorded. Results: Among 330 infants, 156 (47.27%) had REFER on first OAE. All 30 infants who had REFER on second OAE had shown hearing impairment on ABR. Hearing loss was seen in three infants (0.90%) without any risk factor. In the present study, risk factors for the hearing impaired infants were NICU stay (39%), low birth weight (33.6%), LSCS (20.6%), preterm delivery (17%), hyperbilirubinemia (8.1%), and delayed cry (7.57%). Statistical analysis performed using the Chi-square test had shown significant association between NICU stay, low birth weight, delayed cry, and hearing loss. Conclusion: Statistical analysis performed using the Chi-square test had shown significant association between NICU stay, low birth weight, delayed cry, and hearing loss. Clinical significance: OAE is good screening tool for newborn and infants.


Original Article

Jaymin A Contractor, Varun J Dave, Saumitra S Nemlekar, Ravi Shah, Ritambhara Y Mehta, Rahul B Patel, Jay N Suratwala

Assessment of Psychological Comorbidities in Patients with Head and Neck Cancer as Compared to Other ENT Patients

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:34 - 36]

Keywords: BDI, HADS, Head and neck cancer, Psychological comorbidity, QOL in HNSCC

   DOI: 10.5005/jp-journals-10003-1373  |  Open Access |  How to cite  | 


Aims and objectives: • To determine the prevalence of psychological comorbidities in head and neck cancer (HNC) patients as compared to other ENT patients. • To determine the number of HNC patients requiring psychiatric treatment as compared to other ENT patients. Materials and methods: A cross-sectional study was conducted. Patients with head and neck carcinoma were selected as cases and appropriate controls were selected after matching for age (±2 years), sex, religion, address, and socioeconomic status. Both groups completed two quality of life questionnaires, Hospital Anxiety and Depression Scale (HADS), and Beck's Depression Inventory (BDI) scale. Further evaluation for depression, anxiety, or any other psychiatric illnesses was done by a psychiatrist. Results: The cases scored significantly higher on the HADS and BDI scale and were found to have a higher incidence of depression, anxiety, suicidal tendencies, and adjustment disorders than their respective controls. Conclusion: The prevalence of psychological comorbidities is significantly higher in head and neck carcinoma patients as compared to other ENT patients. Measuring health-related quality of life should be incorporated as an integral part of the treatment regimen and patient management.



Shivam Agarwal, Rohit Sharma, Vineet Kumar Sharma, Amit Kumar Rana

Effect of Functional Endoscopic Sinus Surgery on Mucociliary Clearance in Patients of Chronic Rhinosinusitis

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:37 - 39]

Keywords: Cilia, Chronic rhinosinusitis, Mucociliary clearance, Nasal physiology, Nose, Saccharine

   DOI: 10.5005/jp-journals-10003-1381  |  Open Access |  How to cite  | 


Introduction: Mucociliary clearance is a nonspecific defense mechanism that removes mucus and other materials from the nose and lungs. During functional endoscopic sinus surgery (FESS) sometimes there is damage to a lot of healthy sinonasal mucosa. This study was carried out to measure the outcome of mucociliary clearance test before and after FESS. Materials and methods: Study group included 44 patients diagnosed with chronic rhinosinusitis (CRS) posted for FESS. Mucociliary clearance testing was performed with saccharine pellets. Observations: The age of patients ranged between 10 and 80 years with 25% between 20 and 30 years and 20% between 30 and 40 years of age. Forty percent of patients had bilateral nasal obstruction as the primary nasal complaint. Nasal discharge was seen in 30% of patients. One-third of patients had complete loss of smell. It was observed that the mean time taken for the concentration of saccharine appreciation in the oropharynx for mucociliary clearance preoperative was 58 minutes. Postoperatively at 6 weeks, it was 14 minutes and 12 minutes at 10 weeks. Discussion and conclusion: Mucociliary clearance as one of the parameters of nasal physiology was evaluated in the patients using saccharine test. Our study revealed after comparing the results in the postoperative period, the percentage was raised from 70% improvement at the 6th week to 85% at the 10th postoperative week. In our study, we saw that the saccharine test was easy to perform, saccharine was easily available, and it was cost-effective and could be applied to all patients of CRS to assess nasal physiology.



Balaji Ramamourthy, Satyawati Mohindra

Rhinocerebral Mucormycosis with Petrositis Presenting with Gradenigo's Triad: A Diagnostic Dilemma

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:40 - 42]

Keywords: Diplopia, Fungal petrositis, Gradenigo's triad, Mucormycosis, Ptosis

   DOI: 10.5005/jp-journals-10003-1370  |  Open Access |  How to cite  | 


Aim and objective: To report a rare case of fungal rhinosinusitis with Gradenigo's syndrome as the presenting feature. Background: Fungal petrositis has been sparingly reported with Aspergillus and Mucor secondary only to infection of mastoid part of temporal bone or intracranial extension. Case description: We report a case of a 50-year-old diabetic male who presented with classical Gradenigo's triad for 3 months duration without any associated nasal complaints and was thereby treated on lines of complicated chronic otitis media (COM). Failure to respond to conventional treatment, diagnostic nasal endoscopy and histopathology helped in establishing the diagnosis of mucormycosis and plan effective treatment. Conclusion: A chronic history suggestive of ear disease and absence of nasal symptoms should not rule out the possibility of mucormycosis, especially in an immunocompromised host. Clinical significance: Rhino-orbital variant can have petrous apex involvement as a complication and in cases where management of COM on conventional lines does not cause improvement of petrositis, fungal etiology should be considered.



Sunil S Kewat, Pravin M Bhat

Management of an Intranasal Open Safety Pin Foreign Body: A Case Report

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:4] [Pages No:43 - 46]

Keywords: Foreign body, Nose, Open safety pin, Pediatric otolaryngology

   DOI: 10.5005/jp-journals-10003-1371  |  Open Access |  How to cite  | 


Background: Foreign body in the nose is a common situation encountered by an otolaryngologist in day-to-day practice. The removal of an intranasal open safety pin has remained a difficult situation in otolaryngology practice, especially in the pediatric age-group. There are numerous challenges with very few literature guidelines for the removal of such intranasal foreign bodies. We encountered such a case of a 4-year-old female child presented with an open safety pin in skiagram. There are several kinds of literature described regarding an open safety pin in the esophagus but silent about the intranasal open safety pin and its management. We have successfully removed the open safety pin under general anesthesia in an uncooperative child. The present manuscript is an attempt to remove the enigma of an intranasal open safety pin management with a video presentation of a rare case event.



Kayvan Aghazadeh, Benyamin Rahmaty, Ali Kouhi, Sasan Dabiri, Saeed Sohrabpour, Maryam Mohammadzadeh, Neda Jafari

Bilateral Facial Nerve Schwannoma: A Case Report and Review of the Literature

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:6] [Pages No:47 - 52]

Keywords: Bilateral hemifacial spasm, Botulinum toxin, Facial nerve schwannoma, Hemifacial spasm

   DOI: 10.5005/jp-journals-10003-1374  |  Open Access |  How to cite  | 


Aim and objective: To show a case with bilateral hemifacial spasm and bilateral facial nerve schwannoma (FNS) and explain few differential diagnoses for the facial nerve schwannomas, clinical presentation, genetic association, and their CT and MRI characteristics. Background: Hemifacial spasm (HFS) is a hyperactive cranial neuropathy that causes paroxysmal facial muscle contraction. Bilateral hemifacial spasm (BHFS) is a very rare neurological syndrome whose diagnosis depends on excluding other facial dyskinesias. Facial nerve schwannoma (FNS) potentially affects any segment of the facial nerve (FN). Bilateral hemifacial spasm caused by bilateral FNS is a rare presentation also. Case description: The patient was a 39-year-old female with bilateral HFS and bilateral FNS. Grade II House-Brackmann Facial Nerve Grading System was observed on the right side of her face. Continuous facial tics were occurring during the examination on both sides of her face, particularly around the left eye. The patient was received bilateral injections of botulinum toxin A. The patient underwent a scheduled close follow-up regarding hearing, facial nerve function, signs, and symptoms. In 1-month, 3-month, 6-month, and a year follow-ups, her symptoms were improved. We performed another MRI following a year, and the sizes of the lesions were equal as the first MRI. The patient was received bilateral injections of botulinum toxin A every 6 months. We decided to follow her up every 6 months for injection and every year by imaging. Conclusion: Surgery is a good option to remove the FNS, but close follow-up and symptomatic treatment, sometimes, are the best approaches when there are no significant facial nerve palsy and hearing loss.



S Juthika Rai, Rakshita R Kamath

Non-Hodgkin's Lymphoma: An Unusual Presentation

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Diffuse large B-cell lymphoma, Non-Hodgkin's lymphoma, Tonsillar disease

   DOI: 10.5005/jp-journals-10003-1380  |  Open Access |  How to cite  | 


Non-Hodgkin's lymphoma especially the diffuse large B-cell lymphoma variety accounts for a considerable fraction of lymphomas. However, their de novo occurrence in the Waldeyer's ring is rare. The independent origin of this condition as a large unilateral tonsillar swelling makes it an interesting presentation in clinical practice. Here, we present such a case with the few known aspects of this condition.



Abhilasha Goswami, Hironya Borah

Ingested Nasopharyngeal Foreign Body in a Young Child

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:2] [Pages No:56 - 57]

Keywords: Ingested foreign body, Nasopharynx, X-ray nasopharynx

   DOI: 10.5005/jp-journals-10003-1376  |  Open Access |  How to cite  | 


Foreign bodies in the aerodigestive tract are a common problem encountered during the practice of otorhinolaryngology. It constitutes a health hazard in all age-groups, but more so among the pediatric population, requiring effective management and immediate intervention. Out of all the reports on foreign bodies in the aerodigestive tract, nasopharyngeal foreign bodies after ingestion are rare. Here, we present a 6-year-old female who presented with noisy breathing and restlessness, following ingestion of jujube seed. On examination, the chest was bilaterally clear and radiograph of the nasopharynx revealed a foreign body in the nasopharynx. The foreign body was removed endoscopically under general anesthesia. This case report is being highlighted for its rarity and unusual presentation. This case also illustrates the importance of nasopharyngeal examination in children with history of foreign body ingestion.



Tze Liang Loh, Adillah Lamry

Migrating Fish Bone in the Neck Complicated with Neck Abscess

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:58 - 60]

Keywords: Abscess, Foreign body, Neck

   DOI: 10.5005/jp-journals-10003-1372  |  Open Access |  How to cite  | 


Accidental ingestion of fish bone followed by impaction within the upper aerodigestive tract is commonly seen in the practice of otorhinolaryngology (ORL) in Asia. When an impacted fish bone is not removed in a timely manner, a relatively unusual phenomenon of a migrating fish bone may occur leading to complications. We hereby present a case of migrating fish bone in a 42-year-old Chinese gentleman, which was complicated by an anterior neck abscess. He presented with the chief complaint of an anterior neck swelling associated with pus discharge and a preceding history of fish bone ingestion 3 weeks ago. Computed tomography (CT) scan of the neck revealed an anterior neck subcutaneous collection with a linear hyperdense foreign body seen within it. He subsequently underwent neck exploration surgery whereby the collection was drained and a long sharp serrated fish bone from within the collection was removed.



Ângela Reis-Rego, Mariline Santos, Telma S Feliciano, Cecília A e Sousa

Temporomandibular Joint Herniation through the Huschke Foramen

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:61 - 63]

Keywords: Huschke foramen, Mass, Temporomandibular joint

   DOI: 10.5005/jp-journals-10003-1377  |  Open Access |  How to cite  | 


Aim: To enlighten about the importance of the anatomic defect—Huschke foramen/foramen tympanicum—in the differential diagnosis of external auditory canal masses, especially when ear complaints are exacerbated by mandibular movements and when in anteroinferior configuration. Background: Most cases of persistent bony defect connecting the external acoustic meatus to the temporomandibular joint are asymptomatic. Although extremely rare, temporomandibular joint herniation through this defect may occur. This entity is not a straightforward diagnosis. Differential diagnosis with tumors involving the ear auditory canal or even cholesteatoma must be carefully excluded. A high-resolution cone-beam computed tomography is the preferred imaging modality for the evaluation of this anatomic variant. Treatment options depend on the presenting symptoms and the patient's willingness to undergo surgical correction. Case description: We report a case of symptomatic temporomandibular joint herniation through the Huschke foramen in an otherwise healthy middle-aged woman who complains of left aural plenitude and intermittent bloody otorrhea for a month. The patient was studied with temporal bone computed tomography and magnetic resonance imaging. While the patient was being studied, there was a complete self-resolution of the mass in the external auditory canal, which we treated with a topical antibiotic and corticosteroid ear drops. Imaging confirmed the existence of a Huschke foramen. Along with the patient, we decided to observe her closely as an outpatient. Conclusion and clinical significance: This report highlights the importance of studying certain external canal masses with imaging, especially in the anteroinferior location, before gross manipulation.



Kritsada Kowitwibool, Tanom Bunaprasert

The First Report on Masseteric–Facial Nerve Anastomosis in Thailand

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:64 - 66]

Keywords: Dynamic facial reanimation, Facial palsy, Facial reanimation, Masseteric nerve, Masseteric to facial reanimation, Nerve anastomosis, Nerve graft, V-VII anastomosis

   DOI: 10.5005/jp-journals-10003-1375  |  Open Access |  How to cite  | 


Aim: To demonstrate the first report on Masseteric–facial nerve reanimation in Thailand. Background: Facial nerve paralysis is devastating for patients. Most of the patients suffer from stigma and social phobia. There are many options for treating the facial nerve paralysis including dynamic and static procedures dependent on the patient situation. Masseteric–facial nerve reanimation is a dynamic procedure suitable for the patient in the absence of a proximal facial nerve stump, with low donor site deformity and being easy to train in the postreanimation phase. We applied the first facial reanimation by masseteric–facial nerve anastomosis to a Thai patient. Review result: The patient had right facial nerve paralysis from the right temporal bone fracture in a motorcycle accident. The patient developed delayed onset of complete paralysis. After exploration, operative findings showed a torn right facial nerve at the tympanic segment of the geniculate ganglion and second genu. Masseteric–facial nerve anastomosis was applied for this patient. The right greater auricular nerve was used for the nerve graft to connect between the proximal stump of the masseteric nerve and the distal stump of the main trunk facial nerve. There were no postoperative complications. After 3 months, the postoperative facial muscle tone returned and after 4 months, when the patient tried chewing using the masseter muscle, some movement of the facial muscle was detected. Conclusion: Masseteric–facial nerve reanimation is the treatment of choice for dynamic facial nerve reanimation in facial nerve paralysis patients where the proximal nerve stump is absent or in the cases of intratemporal injury to the facial nerves.



Zheng H Loh, Tuck K Chow

Swelling of the Nasal Septum: A Case of Nasal Septum Carcinoma

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:67 - 69]

Keywords: Nasal septum carcinoma, Nasal septum swelling, Squamous cell neoplasm

   DOI: 10.5005/jp-journals-10003-1378  |  Open Access |  How to cite  | 


Objectives: To report a case of nasal septum carcinoma. To review the existing literature on the presentation, staging, and management. Results: A 70-year-old gentleman presented with soft, smooth swelling of the anterior nasal septum for a duration of 1 month. CT contrast showed a hypodense soft tissue arising from the left nasal septum without bony erosion, with the mass measuring 1.8 × 2.6 cm, displacing the nasal septum to the right. Post-excision histopathological examination reported a keratinizing squamous cell carcinoma of poorly differentiated type with margin involvement. He was started on radiotherapy and successfully completed it. Conclusions: Mass in the nasal cavity is the second most common presentation of nasal septum carcinoma. Treatment of nasal septum carcinoma depends on the site and extension of the lesion. Postoperative irradiation is important depending on the clearance and cartilage involvement. The above tumor is T1 according to staging but is of relatively large size. According to the previous meta-analysis, a T1 tumor can be treated with radiotherapy alone. Another study showed that tumor that is more than 2 cm in size is better treated with combined therapy, without mentioning about the stage of the tumor. To reach better treatment, both criteria must be taken into consideration. A better staging system that involves location and size of the tumor will help in better treatment and prognosis.



Shama A Bellad, Indresh Chandra, Priti S Hajare

Keratosis Obturans: A Perilous Disease?

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:70 - 72]

Keywords: Fistula, Keratin plug, Keratosis, Nystagmus

   DOI: 10.5005/jp-journals-10003-1383  |  Open Access |  How to cite  | 


Aim: To find out the extent of simple disease like keratosis obturans and possible complications it can give rise to. Background: Keratosis obturans was first properly described and named by Wreden of St. Petersburg in 1874, who differentiated the condition from that of impacted wax (which was then called ceruminosis obturans). Keratosis obturans is the accumulation of a large plug of desquamated keratin in the external auditory meatus. It is thought that keratosis obturans is due to abnormal epithelial migration of the ear canal skin. We are presenting a rare case of keratosis obturans with lateral semicircular canal fistula. Case description: A 56-year-old female presented with right ear discharge since 15 days and giddiness with vomiting since 5 days with past history of right ear discharge since 5 years. Clinical examination revealed keratin plug in right external auditory canal and posterior meatal wall bulge with dull tympanic membrane. Otoendoscopy shows wax with keratin debris and pulsatile discharge. Patient had horizontal nystagmus, gaze evoked with head shake test positive. Fistula sign was negative. High-resolution computed tomography (HRCT) temporal bone showed erosion of lateral semicircular canal and no ossicles. Modified radical mastoidectomy with type 4 tympanoplasty was done. Keratin debris with wax was seen in attic and aditus. Fistula closed using periosteum. Intraoperatively, patient developed facial nerve weakness which recovered postoperatively. Conclusion: We were able to treat the patient by prompt intervention and diagnosis of the condition resulting in adequate recovery of the patient. Clinical significance: Keratosis obturans is a rare disease, and the true incidence of this is not known with its natural history and progression. High clinical suspicion and prompt management are important as treatment delay results in serious complications.



Anmol Wadhwa, Bhavika Verma, Yogesh G Dabholkar

Isolated Primary Laryngeal Amyloidosis: A Case Series of a Rare Presentation of Change in Voice

[Year:2021] [Month:May-August] [Volume:13] [Number:2] [Pages:3] [Pages No:73 - 75]

Keywords: Amyloidosis, Hoarseness of voice, Laryngeal

   DOI: 10.5005/jp-journals-10003-1384  |  Open Access |  How to cite  | 


Introduction: Amyloidosis is a benign disease which comprises heterogeneous group of disorders that are characterized by accumulation of amyloid proteins in various body organs. Of the various types, laryngeal amyloidosis is a rare disease of unknown etiology. Case report: We report three cases of isolated primary laryngeal amyloidosis who presented with hoarseness of voice as their chief complaint. A diagnosis was made based on histopathology after a thorough clinical and laboratory workup, and the patients responded well to the surgical excision of the growth and to a combination therapy of oral corticosteroids and bortezomib. Conclusion: Laryngeal amyloidosis, though a rare disease, is a common site for isolated amyloid deposits to occur in head and neck regions, and its diagnosis requires a high index of suspicion as well as thorough workup to exclude systemic involvement.


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