Journal of Otorhinolaryngology and Facial Plastic Surgery

Background: Esophageal perforations can lead to air entering the mediastinum, resulting in pneumomediastinum and potentially life-threatening complications. Prompt identification and management of foreign bodies are critical in such cases.

Case Presentation: This case presents the incidental discovery of a hyperdense foreign body in the middle two-thirds of a patient’s esophagus, identified on computed tomography (CT) imaging following a prior diagnosis of pneumomediastinum of unknown origin. The foreign body’s potential involvement in the pneumomediastinum presented diagnostic and management challenges for the medical team, as the patient had no prior history of ingesting a foreign object. Further investigation into the patient’s dietary habits, coupled with the CT findings, ultimately revealed that the hyperdense object was bubble gum.

Conclusion: The hyperdense appearance of bubble gum on X-ray and CT scans resembles bone, making it difficult to distinguish without a detailed patient history. Although no causal relationship between the foreign body and the pneumomediastinum was identified, this case underscores the significance of meticulous imaging evaluation and the necessity of considering both prevalent and uncommon etiologies during the diagnostic process.

Background: Pott’s spine describes tuberculous infection of the spine and the term “Pott’s paraplegia” describes paraplegia resulting from the tuberculosis of the spine. Tuberculosis is a disease of poverty that affects mostly young adults in their most productive years. The progression of spinal tuberculosis is slow and insidious. Formation of a cold abscess around a vertebra is another characteristic feature of spinal tuberculosis. Retropharyngeal abscess can produce considerable pressure effects such as dysphagia, respiratory distress, or hoarseness of voice. Therefore, early diagnosis and treatment in life-saving in these patients.

Case Presentation: A 16 year old female patient presented with neck pain, difficulty in swallowing, slight restriction of neck movements and history of fever and night sweats. A detailed history was taken and complete examination was done. A swelling in posterior pharyngeal wall was seen and drained and the pus collected was sent for culture and sensitivity and for confirmation of the Tuberculosis. Radiological investigations were done which revealed retropharyngeal abscess and the extent of involvement of the craniovertebral junction. After confirmation of tuberculosis, antituberculosis treatment was started and patient was followed up and showed remarkable improvement.

Conclusion: Craniocervical junction tuberculosis is a rare disease with dangerous outcome if not diagnosed and treated early. antituberculosis therapy is the mainstay of conservative treatment for early diagnosed cases and has good prognosis.

Background:

Rhinolith is a rare condition explained as the mineralization of intra nasal foreign body. It can be asymptomatic and diagnosed incidentally or presents with nasal obstruction, mal-odor nasal discharge, facial pain, epistaxis and etc. it is usually unilateral. Bilateral rhinolith is extremely rare

Case Presentation: A mentally retarded 34 year old female with history of unknown foreign body insertion into nasal cavities in childhood and complaints of bilateral nasal obstruction and nasal discharge for 30 years referred to ENT clinic. Nasal examination revealed bilateral mucopurulent discharge and a yellowish mass on the floor of left nasal cavity below the middle turbinate. CT Scan findings showed calcified masses in right and left nasal cavities and mucosal thickening of right maxillary sinus. Based on clinical history, physical examination and imaging findings the diagnosis was bilateral rhinolith. Rhinoliths were removed by endoscopic approach and all her symptoms relieved after surgery. 

Conclusion: Although it is rare, bilateral rhinoliths should be considered in differential diagnosis in patients with prolonged bilateral nasal obstruction and bilateral nasal discharge.

Background: Oronasal fistulae (ONF) can remain after surgery in some cleft palate patients. Repairing ONF requires surgery through the intraoral route, which may black the airway during the procedure. Tongue flap surgery is the surgical technique to fix ONF. The latter involves dividing and transplanting the tongue flap from the dorsal tongue to the palate, which can cause many challenges to the anesthesiologist.. This is particularly difficult as the nasal route cannot be accessed in pediatric patients undergoing general anesthesia for tongue flap division surgery. We present a challenging case of difficult airway management in a 6-year-old child with tracheal stenosis posted for tongue flap division surgery.

Case Presentation: A 6-year-old male, 15 kg, diagnosed with bilateral cleft lip and cleft palate with tongue flap, was scheduled for tongue flap division and anterior palate fistula repair. Establishing an airway was difficult due to the presence of the tongue flap and a restricted mouth opening. Additionally, the patient had a previous difficult intubations due to subglottic stenosis, documented during anterior palate fistula repair conducted one month earlier. Inside the OT, standard monitors (NIBP, ECG, Pulse oximetry, and a temperature probe) were attached. We planned to perform fiberoptic intubation through the mouth. However, in our setup, the smallest size of ETT that could be loaded over pediatric fiberscope was 4.0 mm, as our institution does not have a neonatal fiberscope. As the previous anesthesia records during ONF repair with tongue flap showed possible intubations 3.5 mm cuffed ETT after the third attempt, we were left with no other option than to use an uncuffed size 4.0mm ETT via fiberscope. We were prepared for the potential challenges and informed the surgeons about alternative options if needed. After preoxygenation, the patient received intravenous (IV) glycopyrrolate 0.01 mg/kg, fentanyl 1 mcg/kg IVand a loading of dexmedetomidine 1 mcg/kg thereafter an infusion of 0.4 mcg/kg/hr IV. Topical anaesthesia was achieved intraorally with 2-3 puffs of 10% lignocaine spray. An uncuffed ET tube of size 4.0 mm was loaded on the fiberoptic scope. The senior consultant, an expert in FOB intubation, attempted oral intubation by gently passing the scope through the side of the tongue flap. Oxygenation was given through nasal prongs, and spontaneous ventilation was maintained. Once the glottic opening was visualized, the tip of the fiberscope was gently advanced and placed just proximal to the vocal cords. At this point, injections of propofol 30 mg and succinylcholine 30 mg were given. The fiberscope was advanced through the vocal cords, and the airway was secured. The surgery took 1 hour, during which the tongue flap was removed, and the palate repair was performed. The patient's recovery was uneventful.

Conclusion: Comprehensive airway management plan should be sorted beforehand to avoid crisis. Intubation via an FOB offers an effective method to secure the airway in such challenging cases.

Background: Basal cell carcinoma (BCC) is the most common non-melanoma skin malignancy, which may frequently affect the nasal region. Reconstruction of the nasal sidewall defects presents a significant functional and aesthetic challenge. The modified perialar crescentic advancement (PACA) flap offers a single-stage and reliable surgical option.

Case Presentation: We describe a 61-year-old woman with a 3x3cm BCC on the right side of the nasal side. Following a complete excision with a 5 mm margin, the defect was reconstructed using a modified PACA flap. In the flap design, we utilized the medial cheek as a donor site, with a crescentic excision along the alar groove to achieve optimal contour. The histopathology confirmed complete excision with tumor-free margins. The patient had an uneventful recovery, with satisfactory functional and cosmetic outcomes at 2 months of follow-up.

Conclusion:  The PACA flap is a versatile, reproducible technique for medium to large nasal sidewall defects, allowing excellent aesthetic integration and minimal donor site morbidity.

Background: Secure fixation of the caudal septum to the anterior nasal spine (ANS) is critical for stable rhinoplasty outcomes. However, there is no standardized method for intraoperative verification of suture engagement in the ANS periosteum, creating a potential for fixation instability

Case Presentation: We present a representative surgical case to illustrate the “Paun Maneuver,” a novel intraoperative pull test. During an open rhinoplasty procedure for nasal framework reconstruction, a 3-0 polydioxanone (PDS) cutting suture was passed deep into the periosteum of the ANS. Before securing the suture, the maneuver was performed by applying firm anterior traction to both suture ends. The resulting immobility of the entire head–nose complex provided immediate tactile confirmation of a secure and deep periosteal bite. Following this successful verification, the posterior septal angle was definitively anchored to the ANS using a horizontal mattress configuration. The procedure was completed without complications, ensuring a stable foundation for subsequent tip reconstruction.

Conclusion: The Paun Maneuver is a simple, rapid, and reproducible technique that addresses a critical gap in septal fixation. By providing real-time, tactile verification of secure periosteal anchoring, it ensures confidence in surgery and reduces the risk of unrecognized fixation failure, thereby contributing to more predictable and durable rhinoplasty outcomes

Background: Acute Otitis Externa (AOE) is diffuse inflammation of the external auditory canal. Findings show a narrowed, tender and erythematous external auditory canal. There are no concrete methods in the management of AOE. Current methods include aural toileting and application of topical agents. Betamethasone Valerate, a Corticosteroid and 0.1% w/w of drug is used most commonly. The commercially used 10% Ichthammol Glycerine solution is a mixture of pure Glycerol [C3H8O3] in a 9:1 ratio with Ichthammol.

Aim: To compare Betamethasone Valerate & Ichthammol Glycerine in the management of Acute Otitis Externa.

Methods: All patients presenting to the Department of Otorhinolaryngology of a Rural Hospital in South India diagnosed with AOE between were included in study. Thirty were assigned to each group. Group A had IG and Group B had BV placed in their ear canal with the help of a sterile cotton wick at 0, 24 and 48 hours. The Visual Analogue Scale and Edema Erythema Index were used as parameters of assessment.

Results: The EET improvement stood at 51.31% in Group A. The EET improvement stood at 47.96% in Group B. In Group A, VAS had an improvement of 63.85%. In Group B, VAS had an improvement of 49.42%.

Conclusion: The use of IG was found to be superior to BV in the management of AOE. IG provides relief from topical allergy and irritation along with reduction of edema. Since IG is cheaper and easy to procure, it can be used as a first line treatment in the management of AOE..

Background: Oropharyngeal carcinoma (OPC) remains a significant health concern in India, particularly driven by tobacco use. While human papillomavirus (HPV)-associated OPC is increasingly common in Western countries, the Indian clinical landscape presents a distinct pattern.

Aim: Evaluation of the clinical presentation, risk factors, treatment modalities, and short-term outcomes of 50 OPC patients treated at a tertiary care center in Delhi over two years.

Methods: This is a cohort study on patients diagnosed with OPC between January 2023 and December 2024. Data included demographics, risk exposures, staging, treatment, and follow-up.

Results: Of the 50 patients, 76% were male, with a median age of 57 years. Tobacco use was present in 88% of cases. Only 12% of tested cases were HPV-positive. The majority (74%) presented with advanced-stage disease. Most were treated with concurrent chemoradiotherapy (62%), followed by surgery with adjuvant therapy (20%). At a median follow-up of 18 months, the overall response rate was 72%, with 46% achieving complete response.

Conclusion: OPC in Delhi is predominantly tobacco-related and often presents at an advanced stage. Chemoradiotherapy remains the cornerstone of treatment, though early detection and prevention strategies are essential for improving outcomes.

Background: Post-operative pharyngeal pain is one of the major problems with tonsillectomy. Thus, Adequate analgesia is crucial in the immediate post-operative period, which enables the patients to speak and swallow normally. Though there are various routes to administer the anesthetic agents, intraoperative peritonsillar injection of local anesthetics is one of the preferred technique.

Aim: The present study was done to find out the effectiveness of lignocaine with adrenaline versus ropivacaine in controlling post-operative pain and intra operative blood loss.

Methods: The study was conducted at Karuna Medical College, Kerala India, in which patients undergoing tonsillectomy for standard indications were included in the study. The patients were randomly divided into two groups- Group L and group R. The anesthetic agent was then injected into the peritonsillar region. Group L received lignocaine and group R received Ropivacaine. Intraoperative blood loss and pain during swallowing, speech, and at rest were assessed using visual analogue scale at 4, 8, 12 and 24-hours post-surgery.

Results: Lignocaine group showed slightly higher pain levels during swallowing, speaking, and at rest compared to ropivacaine at various intervals. Mean pain scores were significantly lower in Group R, at 4, 8, 12, and 24-hours post-surgery, with p-values <0.05. Additionally, ropivacaine demonstrated superior pain control, particularly during speech and swallowing. No significant correlations were observed between age, gender, or indications and pain levels.

Conclusion: Both ropivacaine and lignocaine with adrenaline can be used as effective local anesthetics in achieving post-operative pain control after tonsillectomy. Ropivacaine provides significantly better postoperative pain control compared to lignocaine with adrenaline in patients undergoing tonsillectomy.

Background: Ear, Nose, and Throat emergencies are common presentations in the emergency department. The ENT emergency spectrum ranges from simple earache and foreign bodies to critical life-threatening conditions like stridor, penetrating neck trauma and severe respiratory distress syndrome. Early diagnosis and prompt management can significantly reduce both morbidity and mortality associated with ENT emergencies.

Aim: To determine the demographic characteristics of patients presenting with ENT emergencies to our institution, and to determine the magnitude, distribution pattern and outcomes of ENT Emergencies at our institution.

Methods: This is a descriptive, retrospective study was conducted in a tertiary care institution in Kanyakumari district of Tamilnadu, India. The study period was for 24 months and included all the patients who presented to the casualty/ENT outpatient department due to ENT emergencies during the study period. The collected data was stored and analysed using Microsoft Excel.

Results: A total of 1700 patients were included in this study with a Male to Female ratio of 1.1:1. The majority of ENT emergencies were related to the ear (60.4%) with otalgia (35.4%) being the most common presenting complaint, followed by bleeding from nose (21.5%). Acute otitis media (29.2%) was the most observed otological emergency followed by otitis externa (25.3%). Foreign body in the nose (28.2%) was the most observed rhinological emergency. 39 subjects presented with stridor and 84.6% of them required a tracheostomy.

Conclusion: ENT emergencies are frequent occurrences in which timely intervention decreases associated morbidity and mortality.

Background: The prevalence of individuals seeking cosmetic surgery necessitates a comprehensive understanding of the psychological factors influencing this decision and the potential for therapeutic interventions to enhance outcomes beyond surgical correction.

Aim: This study investigated the effectiveness of rhinoplasty alone and in conjunction with positive psychotherapy in ameliorating rejection sensitivity and improving self-esteem among women who had sought cosmetic surgery.

Methods: This clinical trial investigated 34 women seeking rhinoplasty in Ahvaz in 2023. Participants were randomly assigned to either a cosmetic surgery group (rhinoplasty alone) or a combined treatment group (rhinoplasty + positive psychology group therapy) (n=17). The positive psychology group therapy involved eight weekly, 90-minute sessions. Key measures included the Rejection Sensitivity Questionnaire (RSQ) and the Rosenberg Self-Esteem Scale (RSES). Data analysis involved Repeated Measures ANOVA in SPSS version 26.

Results: Both groups showed significant reductions in rejection sensitivity from pre-test to post-test (P=0.002), with slight increases at follow-up. Self-esteem significantly improved over time (P=0.001), with the combined treatment group demonstrating higher scores (P=0.009) and significant gains from pre-test to post-test (P=0.016) and follow-up (P=0.001), unlike the cosmetic surgery group (P=0.014 at follow-up only).

Conclusion: Rhinoplasty alone along with its combination with positive psychology group therapy significantly reduced rejection sensitivity and enhanced self-esteem among women undergoing cosmetic surgery, with the combined approach yielding superior and sustained self-esteem outcomes. While rejection sensitivity improvements were comparable across both groups, these findings underscore the value of integrating psychological interventions to optimize self-esteem benefits for cosmetic surgery candidates.

Background: Thyroidectomy techniques have evolved over the last 150 years. Postoperative hypocalcemia and hypoparathyroidism are common. Previous studies have focused on identifying risk factors for hypocalcemia and hypoparathyroidism after thyroid surgery, with inconclusive results. To address this, we aimed to conduct a study to assess the incidence and risk factors of postoperative calcium and hypoparathyroidism after total and subtotal thyroidectomy.

Methods: Patients were included over a one-year period. The data collected included information on demographic characteristics, medical history, surgical details, pre- and post-operative calcium and parathyroid hormone levels, neck dissection, type of disease, and surgery. The statistical analyses utilized paired t-tests, Wilcoxon signed-rank tests, and binary logistic regression in R Studio.

Results: The study included 39 patients with an average age of 61.5. Most patients were male (35 out of 39, 89.7%). Three patients underwent partial thyroidectomy. After the operation, the levels of calcium, corrected calcium, PTH, albumin, and phosphorous significantly decreased. Factors that varied statistically between patients with normal and hypocalcemia were PTH and magnesium levels. Several factors emerged as statistically significant predictors for post-thyroidectomy hypocalcemia and hypoparathyroidism. Factors that statistically predicted the development of hypocalcemia were parathyroidectomy, pre and postoperative parathyroid hormone level, corrected calcium levels, neck dissection, preoperative vitamin D, and postoperative magnesium levels. Besides, neck dissection and pre-operative vitamin D levels predicted the development of hypoparathyroidism.

Conclusion: By assessing pre-operative PTH and corrected calcium levels and adopting a customized surgical approach to minimize parathyroid gland damage, we can lower the risk of postoperative hypocalcemia.

Background: Controlled hypotension is a commonly employed anesthetic technique in rhinoplasty aimed at reducing intraoperative bleeding and improving surgical field visibility. Despite its widespread use, there remains variability in the choice of pharmacological agents and clinical protocols.

Aim: This narrative review provides a comprehensive overview of the mechanisms, pharmacological techniques, and clinical considerations involved in controlled hypotension for rhinoplasty.

Methods: Key studies, clinical trials, and systematic reviews published on controlled hypotension agents including dexmedetomidine, esmolol, magnesium sulfate, and remifentanil were analyzed and synthesized.

Results: Controlled hypotension effectively decreases intraoperative blood loss and enhances surgical conditions. Dexmedetomidine offers stable hemodynamics with sedative and analgesic benefits, while esmolol and remifentanil allow rapid and titratable blood pressure control. Magnesium sulfate serves as an adjunct with vasodilatory and neuroprotective effects. Careful patient selection and continuous hemodynamic monitoring are critical to minimize adverse events.

Conclusion: When applied judiciously, controlled hypotension is a valuable strategy in rhinoplasty anesthesia, improving surgical outcomes and patient safety. Future research should focus on optimizing drug combinations and protocols to further enhance efficacy and minimize risks.

Congenital hearing loss is a major, often underrecognized global public health challenge (1) Its significance stems from the fact that it is among the few pediatric disabilities for which early identification and intervention can profoundly alter developmental outcomes (2). Without detection in the neonatal period, its consequences extend beyond auditory impairment to affect speech, language, cognition, education, social participation, family well-being, and lifetime productivity (2).  In Iran, newborn hearing screening programs have expanded substantially in recent years. A national analysis reported that in 2022, 1,006,293 of 1,106,072 newborns underwent hearing screening, corresponding to a coverage rate of 90.97%. The study also estimated a mean prevalence of congenital hearing loss of 3.3 per 1,000 births and showed that a two-step screening strategy using otoacoustic emissions followed by automated auditory brainstem response is the most cost-effective approach, with an incremental cost-effectiveness ratio of 3297.2 US PPP per quality-adjusted life year (3). These findings are encouraging, indicating that large‑scale newborn hearing screening is both feasible and economically justifiable within the Iranian health system. Nevertheless, screening represents only the initial component of a comprehensive care pathway. Effective early hearing detection and intervention programs must ensure timely diagnostic confirmation, appropriate amplification, early rehabilitative services, and, when indicated, cochlear implantation to achieve optimal developmental outcomes.