“COMPARATIVE STUDY OF FNAC, USG, US-FNAC, AND HPE IN DIAGNOSIS OF NECK SWELLINGS”

ABSTRACT Aims: This prospective study was carried out to compare findings of the four procedures namely FNAC (fine-needle aspiration cytology), USG (ultrasonography), US-FNAC (Ultrasound-guided fine-needle aspiration cytology), and HPE (histopathological examination). MATERIAL AND METHODS Total 80 cases of different neck swellings were selected from ENT OPD at tertiary care hospital Prayagraj Uttar Pradesh. All cases underwent the preoperative procedure of FNAC,USG, US-FNAC and postoperative HPE for diagnosing the neck swelling. The results of FNAC, USG, US-FNAC w e r e c o m p a r e d a n d c o r r e l a t e d w i t h histopathology findings and conclusions drawn after statistical analysis. RESULTS More than half (56.25%) of neck swellings were of thyroid swellings. It was observed that sensitivity, specificity, PPV, NPV, accuracy of FNAC of all neck swellings were 85.71%, 91.78% ,50%, 98.53% ,91.25% respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of USG were 71.43%, 98.63%, 83.33% , 97.26% 96.25 respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of US-FNAC were 85.71% ,97.26% ,75% , 98.61%, 96.25 respectively. CONCLUSION The combined use of USG and FNAC give more accuracy for proper diagnosis of neck swelling than FNAC alone. The most accurate diagnosis of

OSTEOMA OF EXTERNAL AUDITORY CANAL: CASE REPORT

ABSTRACT An osteoma of the external auditory canal is an uncommon benign tumor with an incidence estimated to be 0.05% of total otologic surgery. In head and neck, they most often arise in the frontoethmoidal region and rarely temporal bone. Osteomas usually asymptomatic and discovered incidentally. A 35 male presented with swelling in right posterior superior part of EAC, without any history of ear picking , swimming or trauma. CT temporal bone revealed a solitary osteoma, with was excised surgically. Histopathological examination confirmed Osteoma.

ROLE OF GINKGO BILOBA IN TINNITUS BASED ON TINNITUS HANDICAP INVENTORY

ABSTRACT AIMS AND OBJECTIVES To evaluate whether there is role of Ginkgo biloba in treatment of tinnitus or not, using Tinnitus Handicap Inventory MATERIAL METHODS: The present prospective study, after approval by Institutional Ethics Committee, was conducted in Department of ENT, GMC Jammu from January 2019 to January 2020 on 90 patients with primary complaint of tinnitus. Inclusion criteria- Age: 20 years or above, Duration of tinnitus > 3 months. Informed consent was taken and all patients were asked to complete the THI-Tinnitus Handicap Inventory. All patients were given 50mg of Ginkgo biloba standardized extract LI 1370 (containing 25% flavonoids, 3% ginkgolides and 5% bilobalides). Patients were advised to take three tablets daily for 12 weeks. RESULTS The mean pre-treatment THI score was 43.6 and mean post-treatment THI score (at 12 weeks) was 39.4; the mean change in THI score was 4.2, the result being statistically insignificant (p-value= 0.43). Out of 90 patients, 51 reported unchanged severity of tinnitus, 27 patients reported improvement in severity of tinnitus and 12 patients reported worsening of condition. CONCLUSION According to our study, Ginkgo biloba has no significant therapeutic role in tinnitus. However, the aetiology of tinnitus is multifactorial and Ginkgo biloba could benefit patients with ischemic aetiology. KEYWORDS Ginkgo, biloba, handicap, inventory, tinnitus

LABYRINTHINE FISTULA IN CHOLESTEATOMA AND ITS MANAGEMENT-A RETROSPECTIVE STUDY

Introduction- Labyrinthine fistula is one of the most common intra-temporal complications of cholesteatoma. Objective of study is (1) to evaluate the role of CT Scan in detecting labyrinthine fistulas, (2)to establish fact that fistula grade and location have no correlation with surgical approaches(CWU Vs CWD mastoidectomy approach),(3) to study the impact on hearing after treatment of labyrinthine fistula and(4) establish a management protocol to deal with labyrinthine fistula.

COBLATION ASSISTED CORDECTOMY FOR VERRUCOUS LESION OF BILATERAL VOCAL CORDS

ABSTRACT Verrucous lesions of vocal cord are irregular whitish lesion with papillomatous surface. In head and neck region, it commonly affects oral cavity and larynx. Laryngeal lesions cause hoarseness and breathing difficulty. Biopsy of the lesion is essential to look for malignancy. Early lesions are amenable for endoscopic resection. Endoscopic resection can be done with microlaryngeal instruments or using CO2 laser/coblator for precise resection. Here we discuss the role of coblator in endoscopic resection of verrucous lesion of vocal cords. KEYWORDS Coblation, Verrucous lesion of vocal cords, verrucous carcinoma

RHINO-ORBITO-CEREBRAL MUCORMYCOSIS (BLACK FUNGUS) IN COVID 19 PATIENTS

ABSTRACT BACKGROUND Mucormycosis (Black fungus) is a designated as a rare, rapidly progressive fatal disease of immunocompromised caused by saprophytic fungus of family mucorales. Early diagnosis with prompt medical and surgical treatment is the only tool available. Rhino-orbito-cerebral is the most common subtype. In India we saw a sudden rise in mucormycosis cases during second wave of COVID 19. This necessitated a systematic review of epidemic of mucormycosis in COVID 19. METHODS A Retrospective multi-centric study was conducted at various Government and Private Hospitals of Western UP comprising of 51 cases of Rhino-orbitocerebral mucormycosis with present or recent COVID19 positive status presenting to us during 14th April 2021- 31st May 2021. RESULT Either Type2 Diabetes Mellitus or history of recent use of steroids in high doses was present in all the patients. Contribution of virulence of the Delta strain B1.617.2 is significant. FESS with sino-nasal debridement contributes significantly towards mortality reduction and cost of total treatment by significantly reducing days of Liposomal Amphotericin B therapy. CONCLUSION Early diagnosis with prompt medical and surgical management along with blood sugar control and avoiding use of high dose of steroids remain to key to mortality and morbidity reduction. Keywords: Black fungus, mucor, mucormycosis, rhino-orbito-cerebral, causes, treatment, covid 19, India, sugar, steroids, steam, oxygen, surgery

ROSAI DORFMAN DISEASE MANAGEMENT, ACTIVE INTERVENTION OR WAIT AND WATCH: A CASE SERIES

ABSTRACT Rosai-Dorfman disease (RDD) is a rare histiocytic disorder commonly manifested as histiocytic proliferation of lymph nodes and extra nodal tissues initially described as a separate entity by Rosai and Dorfman under the term sinus histiocytosis with massive lymphadenopathy (SHML) in 1969. The treatment strategies can be variable and based on the severity of disease, v ital organ invol vement and pos s ible complications. The first case was a 47 years old female presenting with nasal obstruction and submandibular lymphadenopathy since few days. The second case was a 8 year old girl presented with stridor and lymphadenopathy in the submandibular region. In both the cases spontaneous resolution was expected and intervention was done only if there werecomplications. Patients were followed up every three months for two years and both the cases have resolved completely without any sequelae of the disease.Here we present two cases of Rosai-Dorfman disease presented to our hospital, this case series adds to the growing knowledge of Rosai-Dorfman di sease, along with under s tanding of pathophysiology, clinical diagnosis, treatment strategies and recovery options in cases where complications occurred.

ROLE OF ELECTRICAL STIMULATION ADDED TO CONVENTIONAL THERAPY IN PATIENTS WITH TRAUMATIC FACIAL PALSY

ABSTRACT Background: Facial nerve palsy can have ophthalmological, Otological, rhinological, taste, and swallowing consequences, in addition to the psychological impact of altered facial expression. Electrical Stimulation (ES) is one of the most debatable and non-evidence-based adjunctive therapies for facial palsy. MATERIAL/METHODS We retrieved the literature on ES in facial nerve injury using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Emphasis was placed on articles and randomised controlled trials (RCTs) published within the last 20 years. Results: The reviewed studies, clinical trials and systematic reviews did not support ES due to a lack of quality evidence to support significant b e n e fi t o r h a r m fr o m E S . T h e v a ri e d methodologies used and the small number of subjects included in the studies could not wholly prove the efficacy of electrotherapy for treating facial nerve injury. CONCLUSION T h o u g h m a n y s t u d i e s h a v e r e p o rt e d improvement of facial movement or function following ES for facial nerve injury, substantial evidence supporting the use of ES in facial palsy is lacking; well-designed rigorous research is required. KEYWORDS Electrical Stimulation, Facial Nerve Palsy, Facial Paralysis

EVALUATION OF ETIOPATHOLOGY FOR HOARSENESS OF VOICE –A CLINICAL STUDY

ABSTRACT Hoarseness of voice is one of the commonest symptoms found in ENT clinics. The present study is to assess etiopathology of hoarseness of voice at our center. The diagnostic potential of laryngeal endoscopy for different laryngeal lesions and its correlation with histopathology is also done. In this retrospective study 126 patients were included. The commonest etiology for hoarseness of voice was found to be chronic laryngitis (51.6%) followed by malignancy (27.8%) and vocal cord paralysis (15.1%). Vocal abuse (33.3%) and smoking (29.4%) were found to be leading predisposing factors. Positive predictive value of laryngeal endoscopy for detecting malignant lesions was found to be 86.5%. Fibreoptic laryngoscopy is a good tool for preliminary evaluation of hoarseness of voice. However, direct laryngoscopy should not be delayed if a diagnosis cannot be made by fibreoptic laryngoscopy KEYWORDS Hoarseness, Laryngeal endoscopy, Voice, Etiolopathology

POSTERIOR AURICULAR NERVE – A NOVEL LANDMARK FOR IDENTIFICATION OF THE FACIAL NERVE IN SUPERFICIAL PAROTIDECTOMY

ABSTRACT Background-Facial nerve identification and preservation is the most critical step in parotid surgery. Though there are described landmarks to locate the facial nerve trunk, they have individual variations. The posterior auricular nerve (PAN) is a branch of the facial nerve and is always present, it can be followed to reach the facial nerve trunk. MATERIALS AND METHODS A retrospective cohort study in which analysis of parotidectomy performed from January 2017 to November 2018 at our tertiary referral center was done. RESULTS A total of 23 parotidectomies were performed, of which 18 cases were pleomorphic adenoma. In four cases of pleomorphic adenoma we could clearly identify and preserve the PAN. Using PAN as the landmark the facial nerve trunk was located, all its peripheral branches were dissected and preserved. PAN identification narrows down the target area of dissection to identify the facial nerve trunk. CONCLUSION The posterior auricular branch of the facial nerve can be used as a standard landmark in parotid surgeries, that almost always leads to the facial nerve trunk. CLINICAL SIGNIFICANCE Though identification of PAN may be difficult in all cases, effort must be made to identify it under magnification. If done meticulously PAN can be an ideal landmark to identify facial nerve in parotid surgery. KEYWORDS Parotid surgery, Superficial Parotidectomy, Posterior auricular nerve, Facial nerve.