Iranian Journal of Otorhinolaryngology
Volume:35 Issue: 2, Mar-Apr 2023

The study aims to evaluate the anatomical and functional success rates of endoscopic push-through cartilage myringoplasty for anterior tympanic membrane (TM) perforations. 

Thirty patients with TM perforations in the anterior quadrant underwent endoscopic push-through cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated.

Out of the 30 patients, 15 were male, and 15 were female. The mean age was 32.60 ± 13.66 years (from 18-60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 37.9 ± 5.83 dB which improved to 27.66 ± 4.88 dB at 16 weeks post-operation. The mean postoperative ABG closure was 7.28 dB with a p-value of 0.001 which was statistically significant.

Endoscopic push-through cartilage myringoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration.

Otomycosis is the common infection of ear caused by fungus generallyfound in tropical and subtropical countries where hot and humid conditions assist these types of infections. Also, the recurrence rate of these infections is high and there is limited therapeutic options,which makes its management challenging. The purpose of our study was to determine the antifungal properties of nanocrystalline silveron patients with otomycosis.The study was carried out in Pune (India) at the Dr. D.Y. Patil Medical college, Hospital and research centre in the department of Ear Nose Throat & Head over a period of one year (2019 -2020). Our study constitutes 100 patients,(58 male and 42 female),with clinicallydiagnosed otomycosis were treated using nanocrystalline silver gel soaked Gelfoam. The Patients which were included in our study were in theage group of 18 to 60 years with highest prevalence in male (58%) aged 30 to 45 years.There were a greater number of cases of infection coming to the hospitali.e., 62 casesduring wet season compare to dry season which were 38 cases. Most common fungus encountered belonged to genus Aspergillus (55%) followed by Candida (45%). 89% of the patients (70% within 5 to 6 days and 19% from 7 to 14 days) symptomatically improved. Use of Nanocrystalline silver cured most of the patients (89%) within 14 days. Treating Otomycosis patients with Nanocrystalline silver showed beneficial results. Study with large sample should be conducted to validate the benefits of Nanocrystalline silver

Recent advances have led to the development of sialendoscopy, an accurate, minimally invasive procedure with high diagnostic and therapeutic capabilities in treating sialolithiasis. This study aimed to evaluate the results and complications of sialendoscopy in patients suffering from sialoadenitis.

This study was a prospective interventional case series study on patients with sialoadenitis due to sludge or stone formation preoperatively confirmed by sonography or computed tomography (CT) scanning. Diagnostic sialendoscopy was performed, and the presence of stenosis, sludge, or stones inside the gland or duct was examined, and surgery was done. During follow-up time (18.8 ± 7.4 months), recurrence of symptoms, the need for reoperation, and postoperative complications were also assessed.

The sialendoscopy was performed in 51 patients, including 55 glands. Forty-five Patients (88.2%) reported pain relief, and 46 patients (90.2%) reported that the treatment using sialendoscopy was better than conservative methods. The duct restenosis also occurred in one patient requiring open surgery. In assessing the main factors predicting the need for reoperation, the site of involvement (parotid versus submandibular glands) and the size of the stone were identified as the main determinants. The best cut-off value for stone size in predicting reoperation requirement was 7.0mm, with a sensitivity of 100% and a specificity of 85.7%.

Intraoperative sialendoscopy is a successful diagnostic and therapeutic tool with minimal postoperative complications in salivary gland duct involvement patients.

Skin tumors are prevalent in the head and neck especially auricle but pilomatricoma is extremely rare in ear lobule.

Case Report:

A 7-year-old girl without a history of previous illness presented with a 1.5-month history of a lesion in the right ear lobule that tended to grow in size. It was a 2*2*2cm round, slightly painful lesion with soft tissue and light red in color that yielded bloody or serous fluid on aspiration. The lesion was enucleated. The diagnosis was pilomatricoma.

Although very rare, pilomatricoma should be considered as a differential diagnosis of ear lobule neoplasms.

An abnormal mass in the head and neck involving the supraglottic and cervical region offers a wide range of differential diagnoses. The pathology is either benign or malignant in nature. Castleman disease (CD) is an uncommon lymphoproliferative disorder characterised by hypervascular lymphoid hyperplasia and is classified into unicentric or multicentric disease. Histopathologically it is divided into hyaline vascular (HV), plasma cell (PC), and mixed cellularity variants. The multicentric disease is linked with PC and has the propensity to progress to lymphoma or Kaposi Sarcoma. 

Case Report: 

We report a case of a 45-year-old gentleman who presented with a painless anterior neck swelling and left supraglottic mass for six months. Computed tomography (CT) contrast imaging demonstrated a homogenous enhancing lesion at the left supraglottic and the midline of the anterior neck with erosive changes of the thyroid cartilage. A surgical resection of the anterior neck mass was performed. The diagnosis of Castleman disease plasma cell variant was made by histopathologic evaluation. The patient remained well post-resection. 

Supraglottic multicentric Castleman disease is the least expected diagnosis in this case. Unicentric disease is treated with surgery. However, limited studies are available in determining the effectiveness of surgery in multicentric diseases. The plasma cell variant requires a multidisciplinary and multimodal approach due to an inclination towards malignancy. Research is needed to determine the role of surgery in multicentric disease and to develop optimum guidelines for managing cases. To date, there is unsubstantial literature describing supraglottic multicentric disease.

Seborrhoeic keratosis (SK) is a benign neoplasm of the skin. They are usually found to occur anywhere in the body except palms, soles and mucous membranes. The skin of the external auditory canal is an extremely rare site for the occurrence of this benign neoplasm. Malignant transformation rarely occurs in this benign condition. It should be differentiated from other malignant condition like squamous cell carcinoma, basal cell carcinoma, Bowen’s disease, malignant melanoma or keratoacanthoma. Surgery is the mainstay of treatment though recurrence is very common. It can be removed by cryotherapy using liquid nitrogen or curettage, light fulgaration, shave removal or painting with pure TCA if the lesion is small. Diathermy shoul be used as minimal as possible to avoid scar formation. 

Case Report: 

An elderly female presented to ENT OPD with left ear blood-stained discharge. On inspection there was irregular blackish mass filling the entire left external auditory canal, fine needle aspiration cytology came to be seborrhoeic keratosis. Since on imaging the tumor was confined to the external auditory canal, it was excised completely by transcanal route. Surprisingly histopathology came to be squamous cell carcinoma. Considering the age and limited confinement of the tumor, she was kept on regular follow up. 

Seborrhoeic keratosis though a common benign tumor, malignant transformation may occur. Treatment is patient specific and may be modified considering the age and comorbidity of the patient.

Ranula is a limited mucus retention on the floor of mouth. Due to the young age of patients, over the years, attempts were made to find minimally invasive and effective surgical techniques. To date, however, there is still no gold standard. The modified micro-marsupialization is an effective and minimally invasive technique, with minimal risk of relapse, although there are very few reports about it. 

Case Report:

A 12-year-old male presented to our ENT Clinic with a rounded swelling with regular and defined margins, measuring 4x3 cm, soft and painless, non-compressible and bluish. Clinical diagnosis of ranula was made and a modified micro-marsupialization was performed: eight interrupted sutures using silk 3-0 were placed perpendicularly to the major axis of the lesion, from one side of the lesion to the other, without reaching the underlying tissue. No sutures were lost during follow-up, no complications occurred. Complete healing was reached after removing sutures on the 30th postoperative day. At 6 months control no relapse was observed.

Modified micro-marsupialization is strongly indicated and recommended, especially in pediatric patient, due to its low invasiveness and its very low relapse rate. The poor case history found in the literature is probably an indication of the lack of knowledge of modified micro-marsupialization which, in our opinion, could be considered the gold standard.