Introduction: Capillary hemangiomas are wide spread vascular tumors in ENT. Its presentation is common in nose while they are relatively rare in tongue and ear. Methodology: A retrospective study of 30 cases wherein majority of the cases came with preceding history of trauma and subsequently they were diagnosed with capillary hemangioma in ear, nose, and tongue. Histopathological picture of hemangioma showed clusters of thin-walled capillaries with single layer of endothelium. All patients were treated by wide excision with clear margin and cauterization, followed for 1 year and no recurrences were found. Result: Wide excision with cauterization of base is essential for the prevention of recurrence of traumatic hemangiomas.

Purpose: The present study aimed at the development of a test of articulation in the Garhwali language. Method: A total of 550 meaningful Garhwali words with all phonemes in their naturally occurring positions, that is, initial, medial, and final were selected. A 5-point familiarity scale was used and was given to 10 Garhwali-speaking adults to rate the word list. Finally, the test includes 110 words. The articulation test was administered to 32 typically developing children in the age range of 3–7 years to obtain normative data. There were four groups such as 3.0–4.0 years, 4.1–5.0 years, 5.1–6.0 years, and 6.1–7.0 years. The mean articulation scores were obtained for each age group. The test material was administered 2 times to the same children to obtain the test–retest reliability. Further, the test was administered on three children with misarticulation to find the face validity. Results: The results indicated that the mean articulation scores increased with an increase in age. The result also revealed that there were relatively lower scores for males than females in all age groups. Conclusion: The present study concludes that the articulation test in the Garhwali language is useful and also will help in analyzing speech sound disturbances in Garhwali children.

Aims: To find out the correlation between clinical diagnosis and pathological diagnosis of various sinonasal masses in the North-East Indian Population. Materials and methods: This study is a hospital-based observational cross-sectional study done over a period of 1 year (2020–2021) in the ENT department of a tertiary care Hospital, in North-Eastern India. A total of 40 patients who presented with sinonasal masses to the ENT OPD of our hospital were included in the study. After a detailed clinical history and examination; nasal endoscopy, radiological investigations and biopsy (wherever indicated) were performed. Whenever any surgical procedure was done, the tissue was sent for histopathological examination (HPE). Results: In our study, in 31 cases (77.5%), the clinical and pathological diagnoses were the same, whereas in 9 cases (22.5%), there was discrepancy between clinical and pathological diagnosis. This correlation was statistically significant with p-value of 0.001. Conclusion: We conclude that by thorough clinical, endoscopic, and radiological evaluation we can come to a provisional diagnosis but HPE is necessary to confirm the diagnosis and hence helps in the proper and early treatment of sinonasal mass. Clinical significance: Knowledge of the clinicopathological correlation of sinonasal mass in the North-Eastern Indian population will take us a long way in improving the quality of medical care in this region.

Aim: The study aims to research the incidence of olfactory and gustatory symptoms in coronavirus disease 2019 (COVID-19) patients. Materials and methods • Study design: Cross-sectional study • Setting: Tertiary care hospital in Karnataka, India • Subjects: A total of 100 patients diagnosed with COVID-19 infection by reverse transcription polymerase chain reaction (RT-PCR) were included in the study. • Method: Taste was examined using solutions of salty, sour, bitter, and sweet taste. Two or more wrong answers were considered abnormal. The smell was evaluated using cardamom, soap, talcum powder, cinnamon, onion, mango, rose, paint thinner, lemon and orange. A score of more than 6 was considered normosmia, 6 or less as hyposmia, and 2 or less as anosmia. Results: In this study, 25% (n = 25) of patients had smell disturbance out of which 10 patients had anosmia and 15 had hyposmia. No case of parosmia was seen. A total of 21 patients had complaints of taste disturbance. Among those, 19 (90.5%) presented with ageusia/hypogeusia, and 2 (9.5%) with dysgeusia. The incidence of taste and smell disturbance in this study was statistically significant. A total of 15 patients had both symptoms; 10 patients had isolated smell disturbance and 6 patients had isolated taste disturbance. Conclusion: Coronavirus disease 2019 is continuing to be a health threat in many cities of India. Many of the patients had olfactory and gustatory dysfunction as one of the earliest symptoms, presenting even before testing. This can be made use of by doctors for early diagnosis and management of COVID-19. Clinical significance: This study gives us the statistics of olfactory and gustatory dysfunction in the South Indian population. Early recognition of these symptoms will help otorhinolaryngologists to diagnose and treat COVID-19 in its early stage, hence reducing the complications.

Aim: We endeavor to report a rare case of fibroma of buccal space along with a discussion of its characteristic magnetic resonance imaging (MRI) features. Background: A solitary fibrous tumor is a spindle cell tumor which is a rare tumor of buccal space. It is typically a pleura-based tumor but has also been described in extrapleural and extraperitoneal sites. Case description: A 32-year-old male presented with painless swelling on the right side of his cheek. Radiological investigations were done and MRI revealed an isointense lesion in the T1W image and intermediate signal intensity in the T2W images. Fine needle aspiration cytology (FNAC) showed benign fibroblastic pathology. The swelling was removed by sublabial approach and on histopathological examination it was reported to be fibroma. Conclusion: Typical radiological features point to the diagnosis of fibroma which is confirmed by histopathology. These features should be kept in mind while dealing with a case of swelling of the buccal space. Clinical significance: Fibroma of buccal space, although a rare tumor, should be kept in the differential diagnosis of the swelling of the buccal space.

Background: Congenital cholesteatomas (CCs) are rare epidermal cysts that have been reported to occur most commonly in the middle ear and rarest in the mastoid cavity. They usually present in adulthood and are difficult to detect due to the lack of symptoms. Treatment is usually a canal wall up or down mastoidectomy with good success rates. Case description: We present a rare case of a mastoid CC with posterior external auditory canal wall erosion treated successfully with a simple canal wall-up mastoidectomy. Conclusion: Mastoid CCs still remain a rare entity with a relatively uncomplicated surgical approach. Clinical significance: Clinicians should high index of suspicion and a low threshold for a CT scan in patients with a history of an intermittently discharging ear, a narrowed ear canal, or a posterior canal wall fistula.

Introduction: Rhabdomyomas are rare benign tumors of the skeletal muscle. Regarding location, they can be subdivided into cardiac and extracardiac subtypes. Considering histological features, they can be classified as fetal, juvenile (intermediate), and adult. Case description: A 25-year-old male patient presented with a 3-month progressive dysphagia. Physical examination showed a smooth submucosal bulging of the right retrochrycoid region with anterior displacement of the ipsilateral larynx. Imaging studies [computed tomography (CT) scan and magnetic resonance imaging (MRI)] corroborated the findings in indirect laryngoscopy showing a well-defined nodular formation centered on the right retrochrycoid area that caused the anteromedial displacement of the right hemilarynx. The patient underwent transoral CO₂ laser biopsy and the final histopathologic diagnosis was extracardiac juvenile rhabdomyoma. A transoral laser-assisted resection of the tumor was performed. Conclusion: Although muscle tumors of the hypopharynx are uncommon, rhabdomyoma should be considered in the differential diagnosis of submucosal masses in this region. Complete surgical excision is the treatment of choice.

Aim: To describe a unique finding of necrotic lesions of the peripheral aspect of the body affecting the nose and ears in sporadic cases admitted in the pediatric ward at our center. Background: Infants till 4 months are immune to viral infections. However, a severe viral infection may lead to rapid deterioration with secondary bacteremia. Pseudomonas infection is frequently complicated by necrotic lesions of the periphery, namely, ecthyma gangrenosum (EG). This case series includes five cases which were sporadic coming from suburban areas of two districts of Madhya Pradesh. Case description: All five cases of the age group between 1 month and 10 months had presented with a short history of high-grade fever of 4–6 days, soon followed by the appearance of rashes. Rashes were maculopapular involving thighs and, buttocks with some cases involving the nose and ears. The patients were admitted to the pediatric ward and a complete hemogram, blood sugar, urine analysis, cerebrospinal fluid (CSF) culture, pus culture, antineutrophil cytoplasmic antibodies (C-ANCA) test, and biopsy were done. Antibiotic coverage was immediately started and response was observed. Conclusion: The skin lesions affecting infants associated with fever and rash are very typical in presentation. In this series, the necrotic lesions are peculiar with the involvement of the nose and ears along with the peripheral region. These cases were primarily diagnosed by presentation and confirmed by biopsy and other investigations. Three cases improved while two patients died. Such cases were not seen prior to the study period nor seen later. Ecthyma gangrenosum was concluded to be the final diagnosis comparable to the clinical picture in most cases both with and without bacteremia. Clinical significance: Infantile febrile lesions with skin lesions are a rare clinical entity that should be reported early. They are primarily diagnosed by clinical presentation. If managed timely, serious complications can be avoided.

Introduction: Thoracic duct rupture is an uncommon presentation and usually occurs through trauma or surgery. Case presentation: Here, we present an entirely unique case of recurrent spontaneous thoracic duct rupture in a 34-year-old woman who had three separate episodes of thoracic duct rupture. The first two episodes appear to have been caused by a spontaneous internal jugular vein (IJV) thrombosis whereas the final had no demonstrable cause. The initial presentation was with neck swelling, the second with chylothorax. Management and outcome: This patient was treated with rivaroxaban for the IJV thrombosis while her chylothorax was treated conservatively. Discussion: This case serves as a learning pearl to consider thoracic duct rupture in patients with neck swellings even without apparent traumatic or iatrogenic cause. It also brings to light the idea of previous insults weakening thoracic duct rupture and predisposing patients to recurrent issues.

Schwannoma is a benign tumor of Schwann cells and is seldom to be seen in the auricle. In the literature, very few cases of Schwannomas originating in the pinna were reported. In this article, we described a 35-year-old female patient who presented with right painless auricular mass which was treated by excision under general anesthesia. The clinical and histopathologic features, the differential diagnosis, and the treatment of auricular Schwannoma are discussed.

Pleomorphic dermal sarcoma (PDS) is a rare dermal-based mesenchymal tumor that shares histologic characteristics with atypical fibroxanthoma (AFX), but demonstrates aggressive features increasing the risk of local recurrence or metastases. We report a unique case of a 62-year-old man with a recent history of left-groin PDS, now with a 2-cm pedunculated left tonsillar mass and two hypermetabolic nodules in the left thyroid. Microscopically, the tonsillar biopsy demonstrated infiltrating spindle cell neoplasm composed of highly pleomorphic tumor cells with abundant mitoses. The left hemithyroidectomy specimen also demonstrated similar pleomorphic spindled tumor cells infiltrating thyroid parenchyma with perineural invasion and focal osseous and chondroid components. Immunohistochemically, both tumors were diffusely positive for smooth muscle actin. Focal nonspecific positive staining with p53, SATB2, and S100 was observed in the thyroid tumor. Additional markers, including p40, CK5, p63, pancytokeratin, CAM5.2, S100, SOX10, Melan-A, HMB45, CD45, CD68, CD163, caldesmon, p16, TTF1, PAX8, and calcitonin, were all negative. INI-1 expression was retained. Molecular analysis showed that the tumor harbored PDGFRA deletion of exon 9 and amplification, PTCH1 A300fs*24, MDM2 amplification, CDKN2A/B loss, and FRS2 amplification. Compared with the patient's groin tumor, the current tumors showed similar morphology. Overall, the histologic and immunohistochemical findings are consistent with metastatic PDS to the tonsil and thyroid. Although PDS is commonly found on the sun-exposed skin in the elderly, this case highlights an unusual primary site as well as peculiar locations for the metastasis of PDS. Treatment and management of the patient are also considered.

Epithelial–myoepithelial carcinoma (EMC) is a rare low-grade malignant tumor of the salivary glands. It occurs mostly in the parotid gland and is classically characterized by bilayered duct-like structures in histological examination. Its differential diagnosis includes all primary salivary gland clear cells tumors, and metastasis from renal cell carcinoma. The complete surgical resection with adjacent lymph nodes dissection represents the recommended therapy to ovoid recurrence. In our case, we describe a 37-year-old woman who presented a local recurrence of a submandibular tumor. The clinical examination demonstrated a well-circumscribed submandibular nodule. A surgical excision was performed and the histological immunohistochemical examination confirmed the diagnosis of submandibular EMC. The patient received a radiotherapy treatment and remained disease-free.

Background: Mucormycosis affects immunocompromised and diabetic patients most of the time. Clinically, mucormycosis has six well-known forms based on systemic involvement and rarely occurs in localized form. Case presentation: We describe a case of parotid mucormycosis in an elderly diabetic male patient. Radiological investigations were suggestive of abscess. Mucormycosis was detected on histopathology and fungal culture. The patient had a complete recovery with liposomal amphotericin B and oral Posaconazole. Conclusion: Mucormycosis should be considered as a possible diagnosis in case of any spontaneous abscess in the parotid. Prompt management improves the outcome of mucormycosis.

Penetrating foreign bodies in the neck due to occupational injury may cause life-threatening complications, hence their urgent removal by neck exploration is incumbent. Finding this foreign body in the operative field may sometimes be arduous and demanding for the surgeon. We present a case of a metallic foreign body embedded into the scalene muscles of the neck and share our experience with a relevant review of the literature. Alongside this penetrating foreign body in the neck, what captivates our attention is a dormant foreign body lying in the buccal region for decades which did not demand any removal.

Aim: Report a case of alkaptonuria diagnosed following consultation with an otolaryngologist. Background: Alkaptonuria is a rare genetic disorder with an autosomal recessive inheritance pattern that leads to an increase in homogentisic acid (HGA). Our aim is to raise awareness about the otolaryngology manifestations of the disease and the treatment of this disease. Case description: A 75-year-old woman presented to an ear, nose, and throat (ENT) consultation with a history of progressive bilateral hearing loss and tinnitus. She had a history of joint pain and morning stiffness, which had previously been attributed to osteoarthritis. Physical examination revealed hyperpigmentation of the conchae, sclerae, and both hands. Laboratory tests showed significantly elevated levels of HGA in her urine, leading to a diagnosis of alkaptonuria. Conclusion and clinical significance: Alkaptonuria is a rare genetic disorder that can present with a variety of symptoms, including joint and cardiovascular problems. This case highlights the significance of recognizing unusual symptoms, such as blue discoloration of the ears, as potential indicators of alkaptonuria.

Introduction: The nose and paranasal sinuses are known to be affected by a wide variety of inflammatory, neoplastic, and infectious conditions but the symptoms in each are very similar, thus making the clinical diagnosis very dicey. Case description: This is a report of one such rare case of a middle-ages female who presented with recurrent symptoms fitting into several differentials and was difficult to decipher, each presentation leading to a new diagnosis, when we stumbled upon atrophic rhinitis like symptoms, nasal septal perforation, palatal erosion and later to Wegener's granulomatosis or now known as granulomatosis with polyangiitis (GPA) and finally we found it to be a case of NK T-cell lymphoma of extra nodal variety. The challenges faced in the diagnosis and management have been described in detail. Discussion: Wegener's granulomatosis is itself uncommon in India owing to less reporting and less availability of screening tools which has led us to be more ignorant about its presentation and also its differentials. Both GPA and NK T-cell lymphoma resemble each other closely in histology and need a high degree of suspicion and expertise to differentiate, they have very different treatments and prognoses. We must also distinguish them from the more commoner disease of the tropics which is tuberculosis. Conclusion: The extranodal NK T-cell lymphoma also known as a lethal midline granuloma, which was initially thought to be Wegener's granulomatosis due to their resemblance and the challenges faced in arriving at a final diagnosis emphasizes the rarity of such a case and need for all of us in otorhinolaryngology to familiarize ourselves which such cases, to increase clinical suspicion and also knowledge regarding presentation and management to ensure quick lifesaving treatments as this is a lethal disease.

Congenital granular cell tumor (CGCT), or congenital epulis (CE), is an uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates. It can be found in the jaw, skin, gastrointestinal, and respiratory tract. It is seen more frequently in female neonates. It can sometimes lead to feeding and respiratory problems. The etiology is unknown although origin from vascular pericytes or smooth muscle is speculated. As most of the granular cell tumors are benign, surgical excision of the lesion is the treatment of choice. We here present a case report of a 14-hour-old female infant, who had a solitary mass on the anterior maxillary alveolar ridge. The lesion, which was histologically a CGCT, was removed completely by simple excision.

Background: Nitric oxide, a diatomic free radical activated by phagocytic leukocytes, arginine a catalyzed product that is synthesized by nitric oxide synthases. It is one of the mechanisms which assists in the resolution of inflammation. A review of its effect on healing around dental implants is yet to be studied. Objective: To review the role of nitric oxide on healing around dental implants. Material and methods: A digital search was carried out using Google Scholar, Medline, and PubMed. The most related article was selected for the review. Conclusion: Osseointegration of dental implants is inclined by many factors which affect the bone-implant contact formation process, and it initiates by forming a hematoma, immunomodulation, and angiogenesis following osteogenesis. Nitric oxide shows a biphasic effect on osteoblast and osteoclast activity, which depends on the concentration of nitric oxide and it can be an important factor in achieving successful osseointegration.

Background: Sinonasal illness frequently results in a significant reduction in quality of life, more so in chronic situations. The most frequent issue is a deviated nasal septum (DNS). This study compared the postoperative results for patients who underwent traditional septoplasty and endoscopic septoplasty. Methods: A prospective study conducted on patients, attending the Department of ENT on an in-patient basis who are diagnosed to have DNS, and other associated pathologies like chronic rhinosinusitis, polyps, and nasal cavity mass were selected on a simple random basis for this study from March 2020 to August 2021. The patients were subjected for either conventional/endoscopic septoplasty, postoperatively patients followed up, and assessed for symptom relief [Nasal Obstruction Symptom Evaluation (NOSE) score] and other complications. Results: One of the most common causes of nasal obstruction is a DNS. In our study, second-decade age was more commonly affected, men are more common (60%). Type III and type V are the most common endoscopic type of septal deviations according to the Jain Bhalerao (JB) endoscopic classification. The NOSE questionnaire was given to all patients preoperatively and postoperatively at 1 and 3 months to both the study group, and p-value was calculated, which was <0.001 when compared between conventional septoplasty and endoscopic septoplasty, which indicates it as highly significant. Conclusion: Endoscopic septoplasty is better than conventional septoplasty with regards to better visualization, good access to the posterior part of the septum, better illumination, limited resection and postoperative improvement, and complications are less in comparison with conventional septoplasty.