National trends are showing statistically significant increase in the thyroid surgeries being performed by otorhinolaryngologist surgeons. There is a rising interest among the otorhinolaryngology surgeons subspecializing in head and neck surgeries to increase the horizons in the advancements in thyroid surgeries. Cervical epidural anesthesia (CEA) for thyroid surgeries is gaining popularity over general anesthesia (GA) for the various advantages it offers.

This prospective study was designed to evaluate the effectiveness and ease of thyroidectomy under CEA as compared to GA.

A prospective study of total of 30 patients undergoing thyroid surgery from two teaching hospitals. They were randomly allotted into CEA and GA groups of 15 members each.

In the CEA group, postoperative comfort and economic feasibility were found to be better compared to GA group. The blood volume loss was lesser in the CEA group. The CEA group also offered the added advantage of vocal cord monitoring by voice contact during the surgery. Both the CEA and GA group maintained hemodynamic stability. There were no complications in both the groups.

Even though thyroid surgery is currently being performed mostly under GA, CEA must be considered for thyroid surgeries routinely. CEA offers a number of advantages of GA in selected cases. This study has proved that CEA has distinct advantages over GA in thyroidectomies. Considering the ease and effectiveness of CEA, it is as good as GA, if not better, even in routine thyroidectomies.

Mohammed S, Santosh UP, Pereira N. Comparison of Cervical Epidural Anesthesia and General Anesthesia for Thyroid Surgery. Int J Otorhinolaryngol Clin 2014;6(1):1-4.

Cephalometric assessment of Eustachian tube (ET) parameters and audiological evaluation in Down syndrome (DS) and Chronic Otitis Media (COM) and comparison with controls. The ET length, Total Cranial Base (TCB), Posterior Upper Facial Height (PUFH), Maxillary Depth (MD), s-ba (sella-basion) to Palatal Line (PL) and s-ba to ET length were considered.

The study comprised of 75 subjects of both sexes in the age range of 7 to 20 years. Digital lateral cephalometry was performed for DS, COM and controls (n = 25). Pure tone audiometry (PTA) and immittance audiometry (IA) was performed to assess audiological status.

ET length, PUFH, TCB and MD was found to be significantly reduced in DS and COM. s-ba to PL and s-ba to ET was significantly reduced in DS and COM. The s-ba to PL and s-ba to ET length angle in moderate and severe CHL (Conductive Hearing Loss) was decreased significantly. The s-ba to ET length was significantly decreased in patients with B and C tympanogram.

Aberration in the dimension of the region of the ET can be considered as a predisposing factor for otitis media and conductive hearing loss in DS.

This study was conducted with the aim of clinicopathological evaluation of thyroid swellings.

Tertiary referral centre, Davangere, Karnataka, India.

Retrospective study.

Clinical details, sonological reports, laboratory reports were retrieved from the records for the 110 patients with thyroid swellings who were included in our study, between May 2009 and April 2013 and the data was analyzed. Cytological smears in all patients and histopathology slides in operated patients were retrieved and studied.

The highest incidence (37.4%) of thyroid swellings were found in age group of 21 to 30 years. The youngest patient being 10 years. Females (90%) predominated in this study, male to female ratio being 1:9. Majority of patients (35%) came with complaints of swelling of duration less than 6 months. Among 110 patients, 36.36% of them were treated conservatively, out of which 7 cases (17.5%) were hyperthyroid, 10 cases (25%) were hypothyroid and 23 cases (57.5%) were euthyroid and the remaining 63.63% of them underwent surgery. Of the 110 patients subjected to FNAC, 16 patients (14.54%) were neoplastic and 94 patients (85.45%) were non-neoplastic. Upon correlation with the histopathology report, the sensitivity of FNAC was 78.57%, specificity was 91.07%, with a positive predictive value of 68.75% and negative predictive value of 94.44%. Diagnostic accuracy of FNAC is 88.50%.

FNAC and USG are valuable tools in assessing the need for surgical intervention in thyroid swellings. USG guided aspiration will further enhance the cytological yield and diagnostic accuracy.

Santosh UP, Sunil Kumar KB, Trupthi MC, Boobalan S. A Comprehensive Approach to Thyroid Swellings: Clinical, Sonological, Cytological and Histopathological Correlation. Int J Otorhinolaryngol Clin 2014;6(1):5-8.

The purpose of review is to emphasize on the causes and assessment of elderly with imbalance and fall. Rising elderly population in future leading to increase in falls episode and associated injury will bring neurologists, otolaryngologists, cardiologists, psychiatrists, orthopedicians and occupational therapists under one umbrella for the management of elderly with balance disorder. This will increase in interspeciality mutualism and understanding ultimately leading to achieve goal to help our elderly to have better life.

Rao G, Rao S, Varma R, Bhagwat NM, Chadha MD, Joshi AS, Varthakavi PK. Predicting Malignancy in a Solitary Thyroid Nodule: A Prospective Study on the Role of Color Doppler Ultrasonography. Int J Otorhinolaryngol Clin 2014;6(1):9-14.

Pleomorphic adenoma is a common, benign tumor arising from the major salivary glands, most commonly from the parotid gland. In addition, they may also occur in the minor salivary glands of the hard and soft palate. Intranasal pleomorphic adenomas are unusual and may be misdiagnosed because they have greater myoepithelial cellularity and fewer myxoid stromata compared to those elsewhere. We report a case of pleomorphic adenoma of the nasal cavity arising from the nasal septum.

Using neck ultrasound to evaluate the status of the lymph nodes of a patient with a head and neck cancer is common practice but laryngeal ultrasound could help to receive more information of the tumor.

We report a case of an initially T1a N0 M0 G2 R0 squamous-cell carcinoma of the right vocal cord. Despite regular follow-up, the relapse of the tumor remained undetected. The hypopharyngoscopy and laryngoscopy were performed. The tumor was evaluated with laryngeal ultrasound and to confirm the relapse of the tumor a MRI scan was performed. Endoscopically there was no obvious presence of the tumor. Laryngeal ultrasound facilitated the visualization of the tumor in good quality.

Unfortunately, a total laryngectomy was necessary to treat the relapse of the squamous-cell carcinoma (T4a N0 (0/16) M0 G2 R0).

Despite careful follow-up via laryngoscopy a relapse of the laryngeal tumor was not visible. Using laryngeal ultrasound, the relapse might have been detected sooner.

Dhume V, Kavishwar V. Impact of Bethesda System of Reporting for Thyroid Cytopathology. Int J Otorhinolaryngol Clin 2014;6(1):15-22.

Schwannoma is an extremely rare tumor of auricle. We are presenting a rare case of auricular schwannoma, perhaps the fifth in world literature, with traumatic etiology. Twenty-five years old female presented with swelling left pinna since 6 years following ear piercing. She desires surgery for cosmetic reasons only. Swelling was excised under local anesthesia and sent for histopathological examination. HPE report was suggestive of nerve sheath tumor. No recurrence has reported so far in followup of 9 months period.

The term extranasopharyngeal angiofibroma has been applied to vascular, fibrous nodules occurring outside the nasopharynx. These rare benign neoplasms characterized by a different biological history and clinical features with respect to nasopharyngeal tumors and, for these reasons, they should be regarded as atypical clinical entity.

A 60-year-old male presented to us with a mass in the left nasal cavity since last 1 year. Examination revealed an irregular, pinkish mass arising from the lateral aspect of left nasal vestibule. The mass was excised and sent for histopathological reporting which confirmed angiofibroma. This case is reported for its atypicality being the rarest site of origin with no case reported so far in medical literature.

Tayde PS, Dalwadi PP, Sharma BR, Chavhan J, Pawal P, Joshi A, Bhagwat NM, Chadha M, Varthakavi PK. Solitary Thyroid Nodule: A Clinical Approach. Int J Otorhinolaryngol Clin 2014;6(1):23-29.

Arteriovenous malformations (AVM) are congenital vascular anomalies but are usually first noticed in childhood or adulthood. Head and neck is the most common location for AVM. Extracranial lesions are rare compared to intracranial lesions. The rapid enlargement of the malformation leading to symptoms is usually triggered by trauma or hormonal changes of puberty or pregnancy. Traumatic AVM of the head and neck are very rare. Here we report a case of AVM of cheek in an adult woman developed following a dental treatment. The diagnosis was confirmed by imaging and was treated surgically after angiography and embolization.

Lipomas are benign tumors arising from fat cells. Occurrence of lipoma in retropharyngeal space is very rare entity. To the best of our knowledge, this is the second case of pleomorphic lipoma being reported in the retropharyngeal space. They are usually asymptomatic until they are of large size. We report a case of a large pleomorphic lipoma in the retropharyngeal space, with emphasis on the clinical characters and histologic characteristics of the lesion. These tumors are best managed surgically by a transcervical approach.

Dalwadi PP, Tayde P, Sharma BR, Chavan JA, Pawal PT, Joshi AS, Chadha MD, Bhagwat NM, Varthakavi PK. Not All Low TSH is Graves’ Disease! Int J Otorhinolaryngol Clin 2014;6(1):30-34.

Kamble RC, Joshi AN, Mestry P, Shah M. Ultrasound Imaging of Thyroid Gland. Int J Otorhinolaryngol Clin 2014;6(1):35-46.

Gupta N, Varshney S. Emergency Thyroidectomy: A Rare Case. Int J Otorhinolaryngol Clin 2014;6(1):47-49.

Bist SS, Mishra S, Varshney S, Agrawal V, Harsh M. Soft Tissue Fibrosarcoma Neck Mimicking as Thyroid Swelling. Int J Otorhinolaryngol Clin 2014; 6(1):50-52.