Otorhinolaryngology

Dr. Raghu Nandhan is Consultant ENT Surgeon at Madras ENT Research Foundation (MERF), Chennai a premier tertiary referral ENT care Institute in South India. He specializes in Neuro-Otology, Auditory Implantation & Skull-Base Surgery having received higher surgical training from reputed centers like Manchester and Birmingham in the UK. He is a Fellow of the Royal college of Surgeons of Edinburgh, overseas member of ENT UK and British Cochlear Implant Group. He has a decade of experience with Cochlear & Brainstem Implants at MERF, which is today one of the largest centers in the world for Implantation Otology and he is currently the clinical lead for Otology at this Institute. He holds a PhD in Cochlear Implant Audiology and is also the Research Lead at MERF with keen interest in spearheading the various ongoing and future research programs of the institution. He has around 70 publications in indexed medical journals and has presented research papers in International conferences around the world, where he has received awards. He has co-authored 7 textbook chapters and is one of the very few Indian authors to write chapters in Scott-Brown and Logan-Turner. Apart from his passion to be a competent clinician and skilled surgeon, he dedicates his professional time to being a researcher, academic, medical leader, teacher and trainer for his peers and junior colleagues.

Introduction: Wide spectrum of temporal bone pathology can present with cerebrospinal fluid (CSF) leak. This originates from the defects in the temporal bone that can be spontaneous, traumatic, pathological c and iatrogenic1. Most common routes are from window dehiscence, along fracture lines, inner ear malformations. Complications of CSF leak include otogenic meningitis, temporal lobe abscess and otic hydrocephalus2,3.rnMethods: This Study is a case review of three patients, presented with varied etiology of CSF leaks rnCase 1: Post RTA B/L temporal bone fracture with unilateral CSF otorhinorrhea with total facial palsy with profound SNHL. rnCase 2: Petrous cholesteatoma recurring in a previous mastoid cavity with large tegmen and dural erosion, fungus cerbri and CSF leakrnCase 3: Adolescent girl with unilateral cochleovestibular dysplasia presenting with recurrent meningitis due to spontaneous CSF otorhinorrhearnThe investigations and surgical management of the above will be highlighted. rnResults: All the patients had successful repair of defects to achieve complete arrest of leak by following meticulous approach with a multi-layered closure and post op management with neuro monitoring4. The protocol of CSF leak repair used in our institute will be discussed rnConclusion: CSF otorrhea is a rare entity. Diagnosis is suspected through otorrhea, aural fullness, hearing loss and radiological investigations. Surgery is successful when managed at a tertiary referral centre having an experienced skull base team5. rnrn

Dr. Swati Nair is a Junior Resident, in the Department of Otorhinolaryngology at the Dr. B R Ambedkar Medical College, Bangalore, India. She has published papers in acclaimed international and Indian journals. She is particularly passionate about Head and Neck surgery and actively contributes to the research in the field.

Pleomorphic Adenoma or benign mixed tumor is the most common salivary tumor, accounting for up to two-thirds of all salivary gland neoplasms [1,2]. These are benign tumors. If the minor salivary glands are involved, the most common site is palate [3,4]. The first site of origin in nasopharynx is very rare[5]. A 21-year-old female was referred to us with complaints of gradually progressive, left sided nasal obstruction since 3 years. Plain and contrast- enhanced MDCT scan of the nasopharynx and the parapharyngeal space showed a fairly large ill-defined heterogeneously enhancing soft tissue lesion with internal nodular calcifications involving pharyngeal mucosal space and parapharyngeal space on the left side at the nasopharyngeal level extending onto the oropharynx (Image). The lesion measured about 5.8X 5.1X 3.9 cm in size and caused gross narrowing of the nasopharyngeal airway. There was obliteration of the fossa of Rosenmuller on the left side. The infratemporal fossa was normal and the right side appeared to be free of disease. A lateral rhinotomy and lip split was performed and the maxilla was split in the midline and the tumor was exposed. On digital palpation, the tumor was noted to be extending deep into the left parapharyngeal space and was delivered by blunt dissection as it was a well-encapsulated tumor (Figure 5 & 6). Complete surgical removal of the tumor followed by intermaxillary wiring was done (Figure 7). The wire was removed after 3 months. The patient reported an improvement in symptoms and the nasopharynx was disease-free even at 6 months. On histopathological examination, the tumor was composed of epithelial and stromal elements. The epithelial elements were oriented in cords, tubules and nests, consisting of cells with uniform round nuclei and moderate cytoplasm. The stroma is a mixture of fibrous, myxomatous and focally chondromyxomatous elements. A mild diffuse mononuclear cell infiltration was noted. No evidence of malignancy was seen. The features were suggestive of Benign Mixed Tumor or Pleomorphic Adenoma of the minor salivary gland.

Dr. Yeung Wai Hung, MBBS(HK), MRCSEd, Resident Trainee, Tuen Mun Hospital

Thyroglossal duct cysts (TGDC) are the most common form of congenital neck cyst. Our study aimed to review cases and outcomes in our institution. Retrospective review of 75 patients (35 male, 40 female) histopathological compatible with TGDC managed in our hospitals between 2004-2017 were performed. Age of presentation was bimodal and ranged from since birth to 73. Most common presenting symptoms was neck mass in 73 patients (97.3%). A history of preoperative TGDC infection was present in 13 (17.3%), ruptured with fistula formation in 3 (4%). 31 cases of TGDC in hyo-thyroid region (37.2%) followed by prehyoid in 23 (24.5%) and suprahyoid in 19 (20.2%) and the rest from intralingual to suprasternal. Main preoperative imaging was USG in 62 (82.7%). FNAC was performed in 35 (46.7%). The cyst size ranged 0.5cm to 5cm. Sistrunk’s operation with central hyoidectomy was performed in 73 cases with variable excision of thyroglossal tract. Recurrence occurred in 3 (4.05%). Operations were performed by General and ENT Surgeons in 30 cases (40%) respectively while the rest by either Paediatric or Plastic Surgeons. Complications happened in 11 patients (14.7%), being mostly minor wound problem. There was no mortality. 3 cases (4%) of papillary thyroid carcinoma were found within TGDC. Our patients had age distribution and gender proportions similar to previous findings in literature, while a higher proportion of patients have history of infected cyst. History of fistula was found to be significantly related to postoperative complications (chi-square: P=0.006). Other factors such as age, infection, simple cystectomy, operation by non-specialist were not significantly related to complications or recurrence. Thyroglossal cyst is treated by Sistrunk operation with low morbidity and mortality and recurrence. Fistula formation was noted to be related to complications. Cases of thyroid carcinoma found within the TGDC were reported. This should be discussed with patients with TGDC.

Dr.Mahmoud farouk, MSc. Otology and Audiology-Egypt.He is manager and owner at Hearing Care Clinic otologist and Vestibular Medicine at Egypt Air Hospital and Otologist at Wadi El-Nile Hospital. He Studied Otorhinolaryngology-Head & Neck Surgery Board at faculty of medicine Ain_shams university.he lives in Cairo ,Egypt

Arrest at the seventh week of gestation yields a cochlea that has only 1.5 turns. This is the most common type of cochlear malformation, accounting for more than 50% of all such deformities. Radiographically, the cochlea is smaller than normal and partially or completely lacks an interscalar septum although the cochlea usually measures 8 to 10 mm vertically; it is typically in the 5- to 6-mm range in incomplete partition deformity. Care must be exercised in counting the number of cochlear turns radiographically because this may be difficult to determine even using high-resolution CT. The radiographic diagnosis depends more on cochlear size and the absence of a scalar septum than on the number of cochlear turns perceived. Histologically, incomplete partition appears to be the radiographic correlate of classical Mondini\'s dysplasia .In numerous reported cases, a small cochlea with 1.5 turns possessing an apical scala communis secondary to deficiency in the osseous spiral lamina has been described . Sennaroglu and Saatci have subtyped the incomplete partition deformity into three variants. Type I lacks the entire modiolus and interscalar septa and demonstrates a cystic appearance. Type II has a normal base turn but a cystic apex (“Mondini type”). Recently Sennaroglu has proposed a type III variant with deficient modiolus and partial interscalar septation at the cochlea\'s periphery. Organ of Corti development is variable, as is the auditory neural population. As might be expected, auditory function also is variable, ranging from normal to profound SNHL.SCC deformities accompany incomplete partition of the cochlea in approximately 20% of cases. Mondini deformity is mostly bilateral finding. I reported a case of unilateral Mondini deformity of a male child 3 years old presented with severe to profound hearing loss (Figure).

Henrique F. Pauna is a M.D. and completed his ENT training in 2015. He has his expertise in otopathology and middle ear diseases. He underwent to a Research Fellowship at the University of Minnesota, under the supervision of Dr. Michael M. Paparella and Dr. Sebahattin Cureoglu, from 2015 to 2016. He is now a Ph.D. student at the University of São Paulo – Ribeirão Preto, focusing his research in meningitis and hearing loss. Additionally, he is a volunteer at the University of Campinas, teaching 4th year students about ear anatomy and pathologies of the ear.

Surgical management of otosclerosis is one of the therapeutic options, and differential diagnosis includes ossicular malformations, oval or round window atresia, congenital cholesteatoma, middle ear tumors, or ossicular trauma.\r\n Recent advances in endoscopic surgery have provided greater evolution within the concept of minimally invasive procedures. Endoscopic stapes surgery is becoming one important option to treat otosclerosis, however, only few studies have described their techniques and results.\r\n Here we describe our experience using endoscopic approach on stapes surgery. Eight patients underwent to complete endoscopic stapes surgery. Three of the patients were submitted to conventional stapes surgery with surgical microscope helped with an endoscope. All of the 8 patients were submitted to stapes surgery with local anesthesia. Six patients had their complete audiological evaluation with a closing gap after the surgery. Only one patient had no audiometry after the procedure because of the short period of time after his surgery. The duration of the surgery – endoscopic or conventional – was a longer in endoscopic approach, however it was not significant.\r\n Endoscopic stapes surgery is an option available for training and also an option to treat otosclerosis. Our results may help to improve data regarding this subject.\r\n

Mahmoud Ebrahim is a young doctor who just finished his internship year and has passion for otolaryngology and head and neck surgery. He is a hard working doctor at work who gives his maximum to the care of the patient’s and there well-being. Outside of work he devotes his time in research and publications and attending courses. He is currently working as an assistant registrar in general surgery and attending ENT electives, as he is building up and strengthening his CV to apply for residency outside his home country.

Malignant peripheral nerve sheath tumor (MPNST) is defined as spindle cell sarcomas arising from or differentiating towards the cells of the peripheral nerve sheath. MPNST is extremely rare in the parotid gland and, in most cases, the prognosis is grim. It usually develops in the setting of Neurofibromatosis type-1 (NF1), but can also develop sporadically. Herein, we report a rare case of MPNST of the parotid gland, in a patient with no previous history of NF1. rnrnA 45 years old patient presented with a non-tender right parotid swelling of one-year duration. A sudden increase in the size of the parotid mass over the past two months alerted the surgeon to proceed to investigate the nature of the mass and the etiology of the sudden change in size. The patient’s initial investigations, which included ultrasound imaging of the swelling, fine needle aspiration (FNA), Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI) of the neck and swelling were consistent with a benign pleomorphic adenoma of the parotid gland. However, during the surgery the dissection was difficult and the tumor appeared adherent to the surrounding tissue, which lead to a total parotidectomy, in piecemeal! rnrnThe histopathology revealed a low-grade spindle cell neoplasm exhibiting a diffuse, infiltrative growth pattern, invading into and around salivary lobules, adipose tissue, skeletal muscle bundles and fascia. The morphology and positive s100 & CD34 stains suggested diffuse neurofibroma. Scattered foci of epithelioid cells with increased pleomorphism and mitotic activity were also evident.rnrnThe diagnosis rendered was thus MPNST of the parotid gland arising from a diffuse neurofibroma. The patient was also diagnosed with NF1 based on clinicopathologic correlation with a referral for confirmatory genetic testing. The patient underwent radiotherapy to continue his treatment following the resection of the tumor. rn

Ulugbek Vokhidov during the work showed themself to be a qualified specialist in the field of otorhinolaryngology. They has a wide range of interests in all areas of otorhinolaryngology. Ulugbek Vokhidov and Djakhangir Shamsiev take an active part in public events of the department and institute. They regularly improve their practical and scientific-theoretical knowledge. The team is respected and honored. They are distinguished by purposefulness and initiative in work, responsiveness to others and kindness to others.

In recent years, the most urgent and discussed topic in medicine is the modernization of technological capabilities and the introduction of high-tech methods of treatment. The purpose of the study was to assess the condition of the nasal cavity in patients with chronic recurrent maxillary sinusitis. Methods of research: We examined 45 patients with chronic recurrent maxillary sinusitis who underwent endoscopic examination prior to surgery and intraoperatively. Results: Polyposis proliferation of the mucous membrane was found in 17 patients, and in 6 patients they completely obturated the nasal passages, in 12 polyps went beyond the average nasal passage. Deviation of the nasal septum was found in 18 patients. In 2 patients with an endoscopic examination, a nasal septum was found, in 31 patients hyperemia of the nasal mucosa was visualized. In 18 patients, hypertrophy of the inferior nasal concha was found. In 24 patients in the nasal passages a pathological discharge was found: in 8 cases, in 5 mucosal-purulent discharge, in 11 - in pus. The pathologically curved middle nasal concha was found in 2 cases, bullous hypertrophy of the central nasal concha in 3 patients. Conclusion: The data obtained during the endoscopic examination allow us not only to determine the obstruction of the anastomosis, but also to find out the cause of this obstruction.