Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann ce... more Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann cells which cover the myelinated nerve fibres. The most common site is the tongue while palatal schwannomas are even rarer. A case of schwannoma which was clinically diagnosed as a tonsillar mass (tonsillar hyperplasia) which caused obstructive symptoms in a young male child has been reported here. The patient presented with repeated episodes of sore throat, fever and difficulty in and pain on swallowing, of 6 months duration, along with a recent episode of high grade fever, which subsided with antibiotics. On local examination, it was observed that there was bilateral hypertrophy of the tonsils with congested pillars and that the right tonsil appeared to be more enlarged in size than the left one. The right side anterior pillar could not be separately differentiated from the tonsil. The tonsilolingual sulcus on the right side was obliterated and it was assumed that the palatine tonsil was enlarged and intermingled with the lingual tonsil. Bilateral tonsillectomy was perfomed and the tissue was sent for histopathological examination. The right sided mass turned out to be Neurilemmoma. This case was worth reporting as it highlighted the importance of including schwanomma as an important differential diagnosis whenever a treating physician encountered a tonsillar mass or a mass of unexplained aetiology in the oral cavity, which caused a diagnostic dilemma. A detailed clinical history, physical examination, cytology and radiological assessment helps in differentiating schwanomma in such settings.
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Tympanic membrane perforation is a common cause of hearing loss. Various surgical tec... more Background: Tympanic membrane perforation is a common cause of hearing loss. Various surgical techniques with different graft materials have been described for the treatment of perforations. The most widely used graft materials are the cartilage and temporalis fascia.Methods: We conducted a prospective randomised control longitudinal study to document the post operative hearing outcomes of type 1 tympanoplasty in patients with inactive mucosal chronic otitis media (n=120) using the cartilage palisades tympanoplasty technique (n=60) and temporalis fascia (n=60).Results: It was found that the mean AB (air-bone) gap at 5 months post operatively was 12.35±7.17 dB with temporalis fascia and 11.39±7.907 dB in cartilage palisades tympanoplasty. At 12 months the AB gap was 14.98±9.915 dB in temporalis fascia group as compared 11.41±8.288 dB for cartilage palisades group. Thus, hearing improvement was better in cartilage palisades group, but interestingly the comparison of the air conduction...
Aim: The present study was done to evaluate the role of oral clonidine and atenolol in providing ... more Aim: The present study was done to evaluate the role of oral clonidine and atenolol in providing optimal surgical field in nasal surgeries under general anaesthesia. Material and methods: 60 patients of ASA grade I & II posted for elective nasal surgeries were randomly divided into two groups of 30 each. Patients received 50 mg oral atenolol in group A and 100 ug oral clonidine in group B two hours prior to surgery. Induction and maintainence of anaesthesia was performed by the same standard protocol. Heart rate, systolic and diastolic blood pressure were recorded during the intra-operative and post-operative period. The surgeon, blinded to group allocation, evaluated the quality of surgical field using a predefined Average Category Scale (ACS). The amount of total blood loss was also recorded.
The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classi... more The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classical method and by endoscopically-assisted adenoidectomy using a powered instrument (microdebrider). This study was conducted in a tertiary care center. It included 40 patients divided into two equal groups of 20 each. Group-A patients underwent classical adenoidectomy, while Group-B patients were subjected to endoscopically-assisted adenoidectomy using a microdebrider. Hearing outcome was measured by post-operative pure-tone audiometry and tympanometry. The post-operative average air-bone gap (ABG) was reduced from 19.6 dB to 11.8 dB in Group A and from 17.6 dB to 8.7 dB in Group B (P=0.010). There was reversal of tympanometric curves from type-B and type-C to type-A in 55% of the patients in Group A, while type-A curve was seen in 90% cases in Group B in the post-operative period. Audiological outcomes of endoscopically-assisted adenoidectomy using a microdebrider were superior compared...
In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical v... more In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical variations and obesity are the major risk factors for OSA. Among the craniofacial anatomy, the neck circumference and abnormal craniofacial morphology play an important role in the pathogenesis of OSA. Obesity is the major risk factor for which waist and hip circumference and BMI are considered. The aim of this paper was to evaluate the impact of hyoid position, mandible body length (MBL) and anthropometric measurements on sleep indices in patients with snoring in North Indian population. In this cross-sectional study, we analyzed the position of the hyoid, mandible body length and anthropometric measurements, of 104 patients attending ENT OPD with the complaint of snoring and excessive daytime sleepiness. All subjects underwent a full overnight polysomnography. The position of the hyoid, MBL and the anthropometric measurements were compared with the sleep architecture of the subjects, an...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2021
Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aim... more Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31–74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and...
Introduction: Cardiovocal hoarseness (Ortner’s syndrome) is hoarseness of voice due to recurrent ... more Introduction: Cardiovocal hoarseness (Ortner’s syndrome) is hoarseness of voice due to recurrent laryngeal nerve involvement secondary to cardiovascular disease. Recurrent laryngeal nerve in its course (especially the left side) follows a path that brings it in close proximity to numerous structures. These structures interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. However painless asymptomatic intramural hematoma of the aortic arch, causing hoarseness as the only symptom, is a rare presentation as in this case. Case Report: We report a case of silent aortic intramural hematoma which manifested as hoarseness as the only presenting symptom. A detailed history and thorough clinical examination could not reveal the pathology of hoarseness. The cause of hoarseness was diagnosed as aortic intramural hematoma on contrast computed tomography. Thus the patient was diagnosed as case of cardiovocal hoarseness (Ortner’s syndrome) secon...
INTRODUCTION: Nasal surgery is frequently associated with some amount of morbidity due to adhesio... more INTRODUCTION: Nasal surgery is frequently associated with some amount of morbidity due to adhesions, hematoma formation, crusting, bleeding, pain & discomfort because of nasal antibiotic meshes which are post-operatively inserted. Rarer complications include septal perforations. INS has been widely used by rhinologist to combat these complications. Salinger and Cohen were the first to use INS for surgery of a difficult septum1. Several materials have been used in the past, but now preformed splints are available in the market (silicon and soft splints). INS has been mainly used to reduce the adhesion formation between the septum and lateral wall of nose2. After the emergence of FESS which was a breakthrough in nasal surgery, the incidence of adhesion formation in the nasal cavity has markedly increased because of simultaneous injury to the septum and lateral nasal wall due to repeated in and out manipulation of the endoscope. Raw surfaces are also markedly increased because of use o...
Indian Journal of Otolaryngology and Head & Neck Surgery
Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the later... more Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the lateral border being the commonest site. The treatment strategies mandate surgery followed by appropriate reconstruction as the first line of management. There are many suitable methods of reconstruction of tongue defects after surgery, but the principle of an ideal reconstruction method should provide not only satisfactory structural cosmesis, but also good restoration of function. We present our experience with the skin lined free flaps reconstruction for defects of the tongue and floor of mouth, and present analyses of the functional outcomes of reconstruction. This prospective longitudinal study included 93 patients and was conducted in a tertiary care center in Punjab. All patients underwent free flap reconstruction after tumor removal. The functional outcome of the tongue following reconstruction was evaluated 9 months after the completion of treatment. Functions were assessed and matched with sexes and age-matched normal individuals. The data obtained were analyzed by the student ‘t’ test and the p values < 0.05 were considered statistically significant. The duration of swallowing in patients with FRF flap and ALT flap when compared to the normative was significant (< 0.05). There were changes in configuration and volume of the oral cavity after surgery which generates resonant and articulatory alterations, thus the intelligibility of the patient’s speech is lowered. There is also a restriction in the tongue movements and reduction in the sensations of the reconstructed part of the tongue. Both the free ALT flap and the FRF flap can provide acceptable functional restoration of the tongue after radical tumor resection.
BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes asso... more BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes associated with deranged kidney function and a progressive decrease in glomerular filtration rate (GFR). There are many anatomic similitudes between cochlea and kidney at an ultra-structural level and antigenic level along with comparable physiological mechanisms, specifically, the active fluid and electrolytes transport in the cochlea and the kidney. The purpose of the present study was to determine the proportion, type and degree of hearing loss in patients with renal disease and its comparison according to the stage of CKD. METHODS The study was conducted on 60 patients of chronic kidney disease labelled as stage 3, 4 and 5 on the basis of GFR. An audiogram charted by pure tone audiometry was used to find the degree of hearing loss and its comparison in patients with moderate, severe and end stage CKD was done. The data was collected and analysed statistically. RESULTS The mean age of pat...
Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann ce... more Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann cells which cover the myelinated nerve fibres. The most common site is the tongue while palatal schwannomas are even rarer. A case of schwannoma which was clinically diagnosed as a tonsillar mass (tonsillar hyperplasia) which caused obstructive symptoms in a young male child has been reported here. The patient presented with repeated episodes of sore throat, fever and difficulty in and pain on swallowing, of 6 months duration, along with a recent episode of high grade fever, which subsided with antibiotics. On local examination, it was observed that there was bilateral hypertrophy of the tonsils with congested pillars and that the right tonsil appeared to be more enlarged in size than the left one. The right side anterior pillar could not be separately differentiated from the tonsil. The tonsilolingual sulcus on the right side was obliterated and it was assumed that the palatine tonsil was enlarged and intermingled with the lingual tonsil. Bilateral tonsillectomy was perfomed and the tissue was sent for histopathological examination. The right sided mass turned out to be Neurilemmoma. This case was worth reporting as it highlighted the importance of including schwanomma as an important differential diagnosis whenever a treating physician encountered a tonsillar mass or a mass of unexplained aetiology in the oral cavity, which caused a diagnostic dilemma. A detailed clinical history, physical examination, cytology and radiological assessment helps in differentiating schwanomma in such settings.
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Tympanic membrane perforation is a common cause of hearing loss. Various surgical tec... more Background: Tympanic membrane perforation is a common cause of hearing loss. Various surgical techniques with different graft materials have been described for the treatment of perforations. The most widely used graft materials are the cartilage and temporalis fascia.Methods: We conducted a prospective randomised control longitudinal study to document the post operative hearing outcomes of type 1 tympanoplasty in patients with inactive mucosal chronic otitis media (n=120) using the cartilage palisades tympanoplasty technique (n=60) and temporalis fascia (n=60).Results: It was found that the mean AB (air-bone) gap at 5 months post operatively was 12.35±7.17 dB with temporalis fascia and 11.39±7.907 dB in cartilage palisades tympanoplasty. At 12 months the AB gap was 14.98±9.915 dB in temporalis fascia group as compared 11.41±8.288 dB for cartilage palisades group. Thus, hearing improvement was better in cartilage palisades group, but interestingly the comparison of the air conduction...
Aim: The present study was done to evaluate the role of oral clonidine and atenolol in providing ... more Aim: The present study was done to evaluate the role of oral clonidine and atenolol in providing optimal surgical field in nasal surgeries under general anaesthesia. Material and methods: 60 patients of ASA grade I & II posted for elective nasal surgeries were randomly divided into two groups of 30 each. Patients received 50 mg oral atenolol in group A and 100 ug oral clonidine in group B two hours prior to surgery. Induction and maintainence of anaesthesia was performed by the same standard protocol. Heart rate, systolic and diastolic blood pressure were recorded during the intra-operative and post-operative period. The surgeon, blinded to group allocation, evaluated the quality of surgical field using a predefined Average Category Scale (ACS). The amount of total blood loss was also recorded.
The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classi... more The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classical method and by endoscopically-assisted adenoidectomy using a powered instrument (microdebrider). This study was conducted in a tertiary care center. It included 40 patients divided into two equal groups of 20 each. Group-A patients underwent classical adenoidectomy, while Group-B patients were subjected to endoscopically-assisted adenoidectomy using a microdebrider. Hearing outcome was measured by post-operative pure-tone audiometry and tympanometry. The post-operative average air-bone gap (ABG) was reduced from 19.6 dB to 11.8 dB in Group A and from 17.6 dB to 8.7 dB in Group B (P=0.010). There was reversal of tympanometric curves from type-B and type-C to type-A in 55% of the patients in Group A, while type-A curve was seen in 90% cases in Group B in the post-operative period. Audiological outcomes of endoscopically-assisted adenoidectomy using a microdebrider were superior compared...
In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical v... more In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical variations and obesity are the major risk factors for OSA. Among the craniofacial anatomy, the neck circumference and abnormal craniofacial morphology play an important role in the pathogenesis of OSA. Obesity is the major risk factor for which waist and hip circumference and BMI are considered. The aim of this paper was to evaluate the impact of hyoid position, mandible body length (MBL) and anthropometric measurements on sleep indices in patients with snoring in North Indian population. In this cross-sectional study, we analyzed the position of the hyoid, mandible body length and anthropometric measurements, of 104 patients attending ENT OPD with the complaint of snoring and excessive daytime sleepiness. All subjects underwent a full overnight polysomnography. The position of the hyoid, MBL and the anthropometric measurements were compared with the sleep architecture of the subjects, an...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2021
Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aim... more Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31–74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and...
Introduction: Cardiovocal hoarseness (Ortner’s syndrome) is hoarseness of voice due to recurrent ... more Introduction: Cardiovocal hoarseness (Ortner’s syndrome) is hoarseness of voice due to recurrent laryngeal nerve involvement secondary to cardiovascular disease. Recurrent laryngeal nerve in its course (especially the left side) follows a path that brings it in close proximity to numerous structures. These structures interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. However painless asymptomatic intramural hematoma of the aortic arch, causing hoarseness as the only symptom, is a rare presentation as in this case. Case Report: We report a case of silent aortic intramural hematoma which manifested as hoarseness as the only presenting symptom. A detailed history and thorough clinical examination could not reveal the pathology of hoarseness. The cause of hoarseness was diagnosed as aortic intramural hematoma on contrast computed tomography. Thus the patient was diagnosed as case of cardiovocal hoarseness (Ortner’s syndrome) secon...
INTRODUCTION: Nasal surgery is frequently associated with some amount of morbidity due to adhesio... more INTRODUCTION: Nasal surgery is frequently associated with some amount of morbidity due to adhesions, hematoma formation, crusting, bleeding, pain & discomfort because of nasal antibiotic meshes which are post-operatively inserted. Rarer complications include septal perforations. INS has been widely used by rhinologist to combat these complications. Salinger and Cohen were the first to use INS for surgery of a difficult septum1. Several materials have been used in the past, but now preformed splints are available in the market (silicon and soft splints). INS has been mainly used to reduce the adhesion formation between the septum and lateral wall of nose2. After the emergence of FESS which was a breakthrough in nasal surgery, the incidence of adhesion formation in the nasal cavity has markedly increased because of simultaneous injury to the septum and lateral nasal wall due to repeated in and out manipulation of the endoscope. Raw surfaces are also markedly increased because of use o...
Indian Journal of Otolaryngology and Head & Neck Surgery
Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the later... more Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the lateral border being the commonest site. The treatment strategies mandate surgery followed by appropriate reconstruction as the first line of management. There are many suitable methods of reconstruction of tongue defects after surgery, but the principle of an ideal reconstruction method should provide not only satisfactory structural cosmesis, but also good restoration of function. We present our experience with the skin lined free flaps reconstruction for defects of the tongue and floor of mouth, and present analyses of the functional outcomes of reconstruction. This prospective longitudinal study included 93 patients and was conducted in a tertiary care center in Punjab. All patients underwent free flap reconstruction after tumor removal. The functional outcome of the tongue following reconstruction was evaluated 9 months after the completion of treatment. Functions were assessed and matched with sexes and age-matched normal individuals. The data obtained were analyzed by the student ‘t’ test and the p values < 0.05 were considered statistically significant. The duration of swallowing in patients with FRF flap and ALT flap when compared to the normative was significant (< 0.05). There were changes in configuration and volume of the oral cavity after surgery which generates resonant and articulatory alterations, thus the intelligibility of the patient’s speech is lowered. There is also a restriction in the tongue movements and reduction in the sensations of the reconstructed part of the tongue. Both the free ALT flap and the FRF flap can provide acceptable functional restoration of the tongue after radical tumor resection.
BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes asso... more BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes associated with deranged kidney function and a progressive decrease in glomerular filtration rate (GFR). There are many anatomic similitudes between cochlea and kidney at an ultra-structural level and antigenic level along with comparable physiological mechanisms, specifically, the active fluid and electrolytes transport in the cochlea and the kidney. The purpose of the present study was to determine the proportion, type and degree of hearing loss in patients with renal disease and its comparison according to the stage of CKD. METHODS The study was conducted on 60 patients of chronic kidney disease labelled as stage 3, 4 and 5 on the basis of GFR. An audiogram charted by pure tone audiometry was used to find the degree of hearing loss and its comparison in patients with moderate, severe and end stage CKD was done. The data was collected and analysed statistically. RESULTS The mean age of pat...
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