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Background: Anterior epitympanic recess (AER) is a small anatomical space in the epitympanum anterior to level of the head of malleus. This space has received lot of attention because of its role in cholesteatoma. Dysventilation of AER can lead to retraction pockets and cholesteatomas. Due to the advent of endoscopic middle ear surgeries the visualization of the mucosal folds and spaces have been possible for the past 2 decades. Mucosal folds and spaces play an important role in middle ear ventilation and pathologies obstructing these ventilation pathways can lead to dysventilation resulting in retraction pockets / cholesteatoma. In our study we have analysed the importance of cog with respect to dysventilation syndrome. Materials and methods: This prospective radiological study was conducted at Apollo Hospitals, BG road, Bangalore for a study period of 1 year (January 2021-January 2022). All patients who underwent high resolution CT scan (HRCT) of temporal bone were included in this study. They were divided into 2 groups (Group I & II). For group I HRCT temporal bone of 200 normal scans were included and scans with chronic otitis media, congenital anomaly, temporal bone fractures and tumors were excluded from the study. 50 HRCT temporal bone scans of chronic otitis media with squamous disease were included in group II. Results: 200 HRCT scans were included in the normative data analysis of the temporal bone. Out of 200, 133 had complete cog, 54 had incomplete cog and 13 had absent cog (Table 2). We also calculated the mean diameters of the AER, AP diameter- 4.24 ± 1.3, TD - 3.36 ± 1.05 and VD - 5.3 ± 1.94 (Table 3). Similarly, we analyzed 50 HRCT temporal bone with squamous disease 32 out of 50 had absent cog (Table 4). We also calculated the dimension of AER in diseased temporal bones (Table 5). A paired T test was conducted in order to analyze these values. Conclusion: In our study we performed a radiological evaluation of AER and cog and found that incidence of absent cog is more among individuals with squamous disease than normal individuals. Hence we advocate that absent cog can lead to horizontally oriented tensor tympani that in turn results in dysventilation., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03507-9., Competing Interests: Conflict of Interest / Disclosure StatementThe authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© Association of Otolaryngologists of India 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Facial nerve schwannoma is a rare benign tumor of temporal bone arising from the schwann cells with incidence of 0.8%. They can arise from any segment of facial nerve with geniculate ganglion being the most common and labyrinthine segment the second commonest site. Intra-temporal location is common while only 9% of the cases have extra-temporal or parotid gland involvement. Bony remodeling or scalloping of the facial canal and the surrounding bone is the classic radiological feature of schwannoma. However schwannomas of temporal bone location can show bony erosions. The management option depends on site, extent, facial nerve function and hearing status. Surgery is reserved for large tumors with poor facial functions, hearing loss and giddiness. Giant facial nerve schwannoma with extra-temporal involvement is a rare entity with only handful number of cases reported in the literature. We present a series of two cases of giant facial nerve schwannoma with parotid gland involvement., Competing Interests: Conflict of interestThe authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article., (© Association of Otolaryngologists of India 2022.)

Nasopharynx is a complex region situated at the center of skull surrounded by various vital neurovascular structures. Surgical access to the nasopharyngeal space poses significant challenges due to the position of the internal carotid artery (ICA). Open approaches to nasopharynx utilize the lateral to medial anatomy but the endoscopic endo-nasal approach warrants knowledge about the medial to lateral anatomy. In this study we attempted to find the consistent surgical landmarks for parapharyngeal portion of internal carotid artery at the level of nasopharynx by means of cadaveric and radiological study. Eight fresh frozen cadavers (16 sides) and 30 CT angiography (60 sides) were included in the anatomical and radiological study respectively. Superior aspect of the torus tubarius was taken as the reference point in cadaveric study and C1-C2 interspace was used as the reference point for the radiological study. The distance between the ICA to the landmarks such as fossa of Rosenmullaer, torus tubarius, medial and lateral pterygoid plates were recorded. The mean distance of ICA to the fossa of Rosenmuller was 8.5 ± 1.4 mm and 9.1 ± 1.1 mm in the cadaveric and radiological study respectively. The mean distance between ICA to torus tubarius was 19.8 ± 1.3 mm in cadaveric and 20.6 ± 1.0 mm in radiological study. The mean distance of ICA to medial and lateral pterygoid plates were 25.3 ± 1.4 mm and 18.2 ± 1.4 mm in the cadaveric study and 25.9 ± 1.2 mm and 18.8 ± 1.3 mm in the radiological study respectively. On correlating the measurements between cadaveric and radiological study, the p values were not statistically significant ( p  > 0.05). The closest landmark to the ICA was the fossa of Rosenmuller. ICA was located at the same sagittal plane as that of the lateral pterygoid plate. The nasopharynx is a complex anatomical region closely related to ICA. Inadvertent injury to ICA is one of the dreaded complications of nasopharyngeal surgery. Fossa of Rosenmuller is only few millimeters away from the ICA and must be treated very cautiously. During the endoscopic approach, the ICA is at the sagittal plane as of the lateral pterygoid plate. This must be kept in mind when advancing toward the ICA by keeping intact the lateral pterygoid plate when possible and one should stay in the plane of medial pterygoid plate as the ICA lies posterolateral to it. Cadaveric dissections supported by radiological data would definitely aid surgeons to successfully perform surgeries in nasopharynx., Competing Interests: Conflict of interestNil., (© Association of Otolaryngologists of India 2021.)

Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process., Competing Interests: Conflict of interestThe authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (© Association of Otolaryngologists of India 2021.)

Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I 2 statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort., Competing Interests: Conflicts of InterestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© Association of Otolaryngologists of India 2021.)

There are various subjective as well as objective tools to evaluate the severity of chronic rhinosinusitis (CRS). SNOT-22 is the most commonly used subjective scoring system to determine the severity of CRS. Lund-Mackay (LM) CT scan scoring is widely used as an objective tool in CRS. However LM scores does not correlate well with the subjective tools. We evaluated the modified CT scan scoring system (SN score) for its efficacy in determining the severity of CRS in both subjective as well as objective manner. To correlate the severity of symptoms and CT scan findings in adult patients with chronic rhinosinusitis by estimating the strength of correlation of severity of symptoms of CRS assessed by SNOT-22 scorings with CT scan findings by Lund Mackay scoring system and SN CT scan scoring system. A prospective, observational study was conducted in the tertiary care center from June 2019 to August 2020. The study included 150 adult patients diagnosed with Chronic Rhino Sinusitis resistant to primary medical therapy, who were subjected to CT scan imaging. The symptom severity of CRS was assessed by the SNOT 22 scores. CT scan was done and Lund Mackay scores and SN CT scan scores by the senior author were calculated. The correlation of SNOT 22 score with LM score and Modified CT score were assessed. The correlation of LM score with SNOT 22 score was assessed by plotting Scattered plot diagram, which showed a moderate positive, statistically significant correlation (Person correlation co-efficient: 0.466; p value: 0.032). The correlation of SN CT score with SNOT 22 was assessed by Chi Square test which showed a highly significant, positive correlation ( p value of 0.000793). Our study shows a positive correlation of symptoms assessed by SNOT 22 system with radiological findings analyzed by both LM system as well as SN CT scan scoring system. However, SN CT scan scoring system showed a highly significant positive correlation over LM system as it correlates well with symptoms and also provides a grading of disease severity . SN CT scan scoring system can be considered as a tool for assessing the disease severity both in subjective and objective manner. It can be used in place of subjective tools like SNOT 22 for assessing the severity of symptoms in CRS where subjective analysis of the disease is difficult., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

IgG4 related disease (IgG4-RD) is a fibro-inflammatory disease, with tendency to affect any organ of the body. However, few cases affecting the skull base have been reported in literature. We report one such case in an elderly male, who presented us with a mass lesion in the skull base that mimicked nasopharyngeal malignancy. On thorough clinical history, examination, and investigations, IgG4 Related disease was diagnosed and treatment was started for it. The patient responded well to the treatment and is on follow up., Competing Interests: Conflict of interestThe authors declare that they have no Conflict of interest., (© Association of Otolaryngologists of India 2020.)

Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

The aim of this study is to identify a surgical safe zone in base of tongue surgery. Fifteen Fresh frozen cadavers (30 head and neck regions) were included in the anatomical study. Twenty-two CT-angiogram (CTA) scans of neck were included in the radiological study. Surgical safe zone for base of tongue surgery was studied in cadavers and correlated the same in CTA. Depth of the lingual artery (LA) from the tongue surface and distance of origin of lingual artery from tip of greater cornu of hyoid bone was significantly different when comparing anatomical to radiological study (p < 0.005). On protruded position of tongue, lingual artery appeared more close to the tongue surface and was never encountered posterior to foramen caecum. Preoperative CTA evaluation would over-estimate the depth of LA putting the lingual artery at risk during resection. A surgical safe zone exists posterior to foramen caecum and towards the midline., (© 2020. Springer-Verlag London Ltd., part of Springer Nature.)

Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p  = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the "C-M-S technique" in order to locate the main trunk of the facial nerve., (© Association of Otolaryngologists of India 2021.)

The aim of this study is to evaluate cribriform-lamella (CL) angle and length of lateral lamella (LL) on CT scan and to correlate CL angle with LL length and Keros classification. Retrospective study analyzing 500 CT scans of PNS was performed at a tertiary care hospital. The CT scan anatomy of anterior cranial base was evaluated for Keros, CL angle and LL length. The relationship between these measurements was studied. Keros type I (75.2%) was the commonest finding in our study. Males have increased depth of olfactory fossa but there were no differences between the sides. Type A angle of CL (66.1%) was the commonest with females having an increased CL angle as compared to males. The LL length was 3.6 mm (± 0.8). There were no significant difference between sex/side of LL. Keros was found to be strongly correlated with the LL length whereas it has mild negative correlation with CL angle. There was no correlation between CL angle and LL length. Keros classification is the commonest criteria used to assess the risk of injury to anterior cranial base. However, we have found that the CL angle has an important role to play in the angulation/slope/level of anterior cranial base during endoscopic sinus surgery. CL angle needs to be considered as an important factor during endoscopic sinus surgery., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

The 3rd and 4th branchial arch fistulas are rare conditions which are due to embryological persistence or incomplete developmental anomalies. They have a typical course as described by the embryological development but the presentation of cases with true course as per embryology is rare. These patients usually present with repeated infections, inadequate surgical interventions and recurrences. We present two index cases of 3rd and 4th pyriform sinus fistulas with their varied anatomical course and clinical presentation who were treated by selective neck dissection technique., (© Association of Otolaryngologists of India 2018.)

Peripheral T-cell lymphoma of salivary gland is a rare clinical entity most commonly involving the parotid gland and mimics a salivary gland carcinoma. It has an aggressive clinical course with poor prognosis. Majority of the cases are diagnosed after surgical excision whereas the principal treatment is non-surgical (chemotherapy). Core biopsy is an excellent method of identifying these indeterminate lesions pre-operatively which would avoid unnecessary surgical intervention. We present a case report with diagnostic challenge in identifying peripheral T cell lymphoma of salivary gland with the review of literature., (© Association of Otolaryngologists of India 2018.)

To identify vestibular dysfunction in children after cochlear implant surgery and to study the utility of static posturography in evaluating vestibular function in children. A prospective study was carried out on 25 children between 2 and 7 years of age with sensorineural hearing loss with no overt vestibular dysfunction. All children underwent static posturography using Synapsis Posturographic System (SPS) software (Version 3.0, REV C) using a static platform with foam. The centre of pressure (COP) shift was recorded as statokinesiogram on the software and the mean vestibular, visual and somesthetic scores were obtained. Cochlear implantation (CI) surgery was done with insertion of Med-El Pulsar standard cochlear implant with 12 twin electrodes. Children were evaluated again after 4 weeks of CI surgery (2 weeks after switch on) with static posturography on the same SPS software. The scores obtained were compared with pre op value and data analyzed statistically by paired t tests on SPSS 18 software. The mean age was 4.6 years with range 2-7 years. All the children in the study were able to complete the test with no difficulty and the mean time required for each child was 10.2 min. The mean pre op somesthetic score was 95.16 (SD 1.52) and post op score was 94.06 (SD 1.79). The mean pre op visual score was 86.64 (SD 2.24) and post op score was 82.55 (2.89). The mean pre op vestibular score was 84.11 (SD 2.20) and post op score was 73.66 (SD 4.25). Correlation and statistical analysis of the pre and post values of each score revealed statistically significant reduction in vestibular scores post CI. The vestibular system is at high risk of injury leading to vestibular dysfunction in children during CI. Our study found the static posturography as a simple, fast and efficient tool to screen children for vestibular dysfunction post CI. Identifying the dysfunction early can help in initiating early rehabilitation measures.

Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2-79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.

Aggressive fibromatosis is a broad group of benign fibrous tissue proliferations of similar microscopic appearance that are intermediate in their biological behavior between benign fibrous tissues and fibrosarcomas. They are rare lesions accounting for less than 3 % of all soft tissue tumours. Usual site is extremity whereas head and neck fibromatosis is a rare occurrence. We present a case of aggressive fibromatosis of the infratemporal fossa in a child, which was treated by surgical excision with adjuvant hormonal therapy.

Tracheal stenosis (TS), a challenging problem, is a known complication of prolonged intubation and tracheostomy. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience with severe TS with regards to patient characteristics, cause and management. A retrospective analysis of 20 patients of severe TS treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with severe TS who required surgical intervention. Exclusion criteria were patients with associated laryngeal stenosis and TS due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Descriptive analysis of data were performed SPSS 18. Results of the 20 patients, 17 patients (85 %) developed TS post tracheostomy, or post intubation and subsequent tracheostomy. 13 Patients (65 %) had true stenosis of which 7 patients (35 %) had simple web or circumferential fibrosis and 6 patients (30 %) had complex stenosis. Seven patients (35 %) had granulations causing severe TS which were mostly suprastomal (5 patients), stomal (5 patients) and combined stomal and suprastomal (3 patients). The average length of stenosis was 3.57 cm (0.5-8 cm). Montgomery t tube insertion was a common procedure in 18 patients (90 %) pre or post intervention. Each patient underwent an average of 3.4 procedures during their course of treatment which included rigid bronchoscopy and mechanical debulking, Nd YAG laser, KTP laser, balloon dilatation and use of stents. Among the 7 patients with granulations 100 % successful decanulation was noted with endoscopic management whereas in 13 patients with true stenosis, 10 patients (76.9 %) required open surgical management (8 tracheal resection and anastomosis and 2 tracheoplasty) with 80 % successful decanulation, 2 patients (15.4 %) were treated with endoscopy with 100 % successful decanulation and 1 patient (7.7 %) was a non surgical candidate on stent. Of the total 20 patients with severe TS in this series, 17 (85 %) of patients who were decanulated, asymptomatic on routine daily activities with normal FFB were considered cured. TS is a challenging condition requiring a highly skilled multidisciplinary team for adequate management. Prolonged intubation and tracheostomy are the common causes leading to tracheal stenosis. Simple tracheal stenosis is easier to manage than a complex stenosis which usually requires an open surgical procedure for successful management. Presence of conditions like tracheoesophageal fistula and long segment tracheomalacia are poor factors for successful management. In our cases successful decanulation was possible in 85 % of the patients following a systematic multidisciplinary approach.

Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.

Allergic rhinitis (AR) is a common and chronic health problem with a high prevalence and a significant effect on the health care expenditure. Intranasal steroid spray is recommended as the first line therapy for patients with moderate to severe AR. Our study clinically analysed the use of nasal breathing exercise (NBE) as an adjunct to intranasal steroid spray as a cheap and effective mode of management of AR. A 3 month, parallel, randomized study was carried out in a zonal and tertiary care referral center. In this study, participants (N = 60) with symptomatic AR were administered either a intranasal steroid spray fluticasone propionate (group A) or fluticasone propionate nasal spray and NBE (group B). Participants assessed their symptom severity daily over the 3 month treatment period. The mean total nasal symptom scores were lower in both the groups (5.1 vs. 3.8333 for group A and 5.2 vs. 2.6777 for group B) and the difference was statistically significant (P < 0.05). The patients showed a definite improvement in overall and individual symptoms for both groups with significantly greater reduction in individual symptoms in the group B (P < 0.05). In our study we have found that both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate and the NBE group. Hence NBE is a simple and cost effective measure to reduce symptoms of AR and improve patient satisfaction.

Laryngocele is a benign condition due to abnormal dilatation of the laryngeal saccule. Localized amyloidosis causing laryngocele is a rare entity with few reports in the literature. We present a young male patient with a large combined laryngocele secondary to laryngeal amyloidosis.

Preauricular sinus (PAS) is a common congenital anomaly which is usually asymptomatic and noted on routine otolaryngological examination which requires no treatment. Patients presenting with discharge, recurrent infections and preauricular abscess will require management with antibiotics and surgical extirpation of the sinus tract. We present a rare case of a PAS presenting as a recurrent postaural abscess.

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.

Background: There is a growing evidence that rhinosinusitis may be associated with asthma as different manifestations of the same disorder. Several reports suggest the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis (CRS). Whether ESS has a positive effect on the clinical course of asthma still remains controversial. The aim of this study was to investigate the outcomes of ESS on asthma in patients with coexistent CRS., Materials and Methods: We performed a study to evaluate the effectiveness of ESS in 70 patients of CRS with associated asthma. The study compares changes in symptoms, medication and objective measures like pulmonary function in patients with persistent bronchial asthma and CRS before and after ESS., Results: Following ESS, there was an improvement in the mean asthma symptoms (wheeze, cough and shortness of breath) and asthma medication use. The number of emergency department visits and hospital admissions also showed a reduction postsurgery. Objective analysis with pulmonary function tests revealed an improvement in the predicted scores. Three patients with extensive polyposis showed poor improvement after surgery and needed revision., Conclusions: This study provides corroborative subjective and objective evidence that ESS is efficacious in the management of patients with CRS and asthma.

Antrolith of the paranasal sinuses are rare entity which are usually asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examinations. We report a case which presented to us with features of pansinusitis six months after endoscopic sinus surgery. Radiological examination revealed a discrete bony density in the maxillary sinus blocking the ostiomeatal complex. The bony mass was removed endoscopically from the maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. We present the imaging and review the present world literature on this rare complication of endoscopic sinus surgery.