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Hypocalcemia is an important and common complication following thyroid surgery. The development of postoperative hypocalcemia is likely to be multifactorial in nature. Patients with acute hypocalcemia may present with numbness of the distal extremities, circumoral paresthesia, and/or carpopedal spasm, laryngospasm, seizure and arrhythmias. In most cases, post-thyroidectomy hypocalcemia is temporary, but small percentage (0-12%) are permanent. The present study was a 1-year prospective interventional study conducted at tertiary care center, Jaipur, India. Total 42 patients who underwent thyroidectomy were included in study. Evaluation of Serum and Ionic Calcium Level done Preoperatively and Postoperative at 6, 12, 24 and 48 h and patients who develops hypocalcemia symptoms were recorded and data were analyzed. In our study hypocalcemia was seen in 13 (31%) out of 42 subjects. Ionic calcium in 'All patients' gradually decreased from pre operative 1.28 ± 0.04 mmol/l to 1.14 ± 0.08 mmol/l by 24 h. Highest incidence of hypocalcemia was seen in patients who had Total thyroidectomy + neck dissection (83.3%) compared to other type of thyroid surgery. we concluded that post thyroidectomy transient hypocalcemia is a frequent complication. Serial monitoring of calcium levels preoperatively and postoperatively combined with careful monitoring of signs and symptoms of hypocalcemia is an efficient and cost-effective tool to detect early post thyroidectomy hypocalcemia., Competing Interests: Conflict of interestNone., (© 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.)

Aim: This study aims to collate the outcomes in acoustic and linguistic performances after cochlear implantation in LVAS., Methods: In a hospital-based prospective interventional study, seven prelingual children with bilateral profound sensorineural hearing loss (SNHL) with LVAS were recruited. They underwent unilateral cochlear implantation between December 2013 and December 2015 in the Department of Otorhinolaryngology and Head Neck Surgery at a tertiary care center. Outcomes of auditory and speech performances were assessed in the form of revised categories of auditory perception (CAP), infant toddler meaningful auditory integration scale (IT-MAIS) and speech intelligibility rating (SIR) scores preoperatively, at one and two years follow up., Results: The mean age of implantation was 4 years. The median revised CAP, IT-MAIS, and SIR scores after one and two years of follow-up were 6, 27, 3, and 11, 36, 5 respectively. The mean follow-up duration was 21.3 months., Conclusion: Pre op median revised CAP, IT-MAIS, and SIR scores of 0, 1, 1 showed improvement to 11, 36, 5 at two years follow up which was statistically significant. Hence, we conclude that good functional outcomes post-operatively advocate the significance of cochlear implantation in LVAS., Competing Interests: Conflict of interestAuthors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2021.)

In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules., Competing Interests: Conflict of interestAuthors declare that they have no conflict of interests., (© Association of Otolaryngologists of India 2020.)

To understand the effect of age at implantation on speech and auditory performances of 74 prelingually deaf Indian children after using cochlear implants for 3, 6 and 12 months. We also evaluate the causes of late implantation in this population. Seventy four children who underwent cochlear implantation from December 2013 to December 2015 in the Department of Otorhinolaryngology and Head Neck Cancer in SMS Medical College, Jaipur were participated in this study. To compare the efficacy of cochlear implant, candidates are classified into 2 groups according to the age at the time of implantation: 1-4 years and 4.1-7 years. The sample size is 37 in both age groups. Their auditory performance and speech intelligibility were rated using the Revised Categories of Auditory Perception scales, Speech Intelligibility Rating scales and Meaningful Auditory Integration Scale. The evaluations were made before implantation and 3, 6 and 12 months after implantation. The scores when compared in both the groups revealed that the results were comparable and significant after 12 months of follow up while the scores were not significant after 3 and 6 months. The results were statistically significant when baseline is compared with different postoperative stages. The children implanted before the age of 4 years had significantly better auditory and linguistic performances. At least 12 months of audio-verbal rehabilitation and speech and language therapy are required to compare the effects of cochlear implant in any set of children. Our study shows that hearing impaired children who receive cochlear implantation below 4 years of age acquires better auditory ability for developing language skills., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

Endoscopic sinus surgery is being done more accurately and with better diagnosis and planning with the help of high resolution CT scan. It has played an invaluable role in the delineation of the sinonasal pathology and anatomic variations preoperatively. To correlate the CT scan findings with endoscopic findings with respect to anatomical variants and pathology and evaluation of its impact on surgical planning. A prospective study conducted on 300 patients who presented to the ENT out patient department with sinonasal diseases and underwent Functional endoscopic sinus surgery. There is a need to evaluate and correlate the findings to deduce the extent of relations CT findings have to that of findings observed during endoscopy as they really affect the surgical planning and outcomes.

310 cases of chronic middle ear disease were managed by Intact canal wall tympanomastoid surgery. Intact canal wall tympanomastoid surgery technique used in this study has been compared with the Jansen's classic ICW technique. A retrospective analysis of 310 cases of chronic middle ear pathology managed by Intact canal wall technique over a period of 10 years (January 1996 to December 2005) was conducted. Patients information was collected from the patients record. 310 patients, aged 5-60 years, were managed by Intact canal wall technique and followed for a minimum period of 5 years. The male:female ratio in our study was 1.25:1 (172 males:138 females). The ratio of adult to pediatric patients was 2.7:1 (226 adults:84 children). Out of 274 (88.4%) cases having a regular follow up, 196 (71.6%) were found to be stable. Postoperative retraction of the tympanic membrane was observed in 24 (8.8%) cases and was managed by the placement of ventilation tube. Secretory otitis media was seen in 14 (5%) cases and was managed by myringotomy and placement of ventilation tube. 17(12.4%) cases were revised including recurrent disease (10 cases), residual disease (6 cases), graft failure (12 cases), stenosis of the ear canal (4 cases), meatomastoid fistula (2 case). Our technique of Intact canal wall tympanomastoid surgery takes less time than the classic Jansen's technique, is easily reproducible and taught, is a single stage procedure and can be universally applied to various chronic middle ear pathologies as the primary treatment with low recidivism rate.

Parapharyngeal space tumors are rare and constitute only 0.5-1.0% of head and neck tumors. Minor salivary gland tumor is still rare in parapharyngeal space. We are reporting a case of pleomorphic adenoma of minor salivary gland of parapharyngeal space. A 42-year-old female presented with a history of mass in the oropharynx for 3 years. She presented with "hot potato voice" and dysphagia. CECT and MRI were done, showing large parapharyngeal space tumor. FNAC was suspicious for tumor of nerve cell origin. Tumor was excised using "paramedian mandibulotomy with mandibular swing approach". Histopathological examination was inconclusive, suggesting possibility of extraskeletal myxoid chondrosarcoma, solitary fibrous tumor, neurogenic tumor. On immunohistochemistry, tumor was positive for cytokeratin, EMA (dim), S-100, and P 63 and negative for SMA thus proving the case as myoepithelial cell-rich pleomorphic adenoma.

Objective: Underlay Tympanoplasty with superiorly based circumferential flap for dry subtotal perforations., Study Design: A prospective study of cases with dry subtotal perforations, which underwent surgery between August 2001-Feb. 2004., Setting: Study was conducted on patients attending ENT OPD in S.M.S. Medical College and Hospital from August 2001-Feb. 2004 with dry subtotal perforations., Results: It was noted that 89% of the cases were in the age group of 11 to 40 years, while one case was of 7 years of age and 9% of cases were between the age of 41-50. 50% of the cases had dry ear for less than 3 months while 75% of cases had dry ear for less than 1 year. Graft take rate was 97% with completely healed tympanic membrane. Rejection of the graft was observed in 2% of the cases. Hearing gain of 10-30dB was achieved in 95% of the cases. 7% of the cases suffered minor complications like otitis media with effusion (2%) retraction (2%) and lateralization (1%)., Conclusion: Duration for which ear has been dry did not affect the results. 49% of cases had dry ear for less than 3 months, with good graft take up rate and hearing gain. Pneumatization of mastoids, had a direct relationship with, post operative hearing gain, which ranged from 10-30 dB, in 95% of the cases. We observed, 97% graft take rate. Rejection of the graft was found in only 2% of the cases. 97% of the graft take rate and good hearing gain in our study can be correlated with expertise technique to deal with subtotal perforations.

Tympanosclerosis is a common clinico-pathological entity encountered by the otosurgeon. Its pathogenesis and optimum management have eluded the otologists since time immemorial. The present study was undertaken to study the incidence of tympanosclerosis amongst patients with chronic suppurative otitis media and to study the correlation between the degree of hearing loss and the site of tympanosclerosis. Audiometric and operative findings of 200 patients of chronic suppurative otitis media were analysed. The incidence of tympanosclerosis was found to be 19% (3d cases out of 200 patients). Most cases of tympanosclerosis had a dry ear on presentation (78.9%). When tympanosclerosis was confined only to the tympanic membrane. 83.3% of the cases had an air-bone-gap less than 40 dB. On the other hand, when tympanosclerosis affected both the tympanic membrane and the middle ear. 75% of the cases had an air-bone-gap more than 40 dB. The hearing loss associated with tympanosclerosis was of the conductive type in the majority of cases. Ossicular mobility was found to be normal in 71.1% of the cases.

An unusual case of pneumothorax secondary to inhalation of a vegetative foreign body in a seven month old child is presented here for its rarity. Proper and timely intervention could save the child.

Foreign body ingestion is a well documented entity. Incarcerated oropharyngel foreign bodies are fre quently observed. Care should be taken for the symptoms like dysphagia and odynophagia, even if no positive history for foreign body ingestion is present. Two cases of incarcerated oropharyngeal foreign bodies are presented here who did not report with history of foreign body ingestion.

Firearm injuries to the head and neck contribute to substantial medical, medicolegal, economic as well as social problems. Internal wounds in the head and neck by firearms are usually complicated and are diagnostically and therapeutically challenging cases. Based on four cases of non-fatal firearm injuries, we discuss problems related to firearm wounds, their irregular path, final lodgment of the bullet and their diagnostic and therapeutic consequences. In the present study it was observed that a fatal looking firearm injury can result in a favourable and interesting outcome.

Tracheobronchial foreign bodies especially in infants and children is fraught with respiratory obstruction and even can lead to death if not intervened in time. The patients can present in variable forms but clinical suspicion and management for such cases is an art itself. We report a case of an unusual foreign body in a child of 1 year showing migratory movements from one main bronchus to other.

Traditionally, it has been accepted that chronic suppurative Otitis media is associated with a breakdown in meekanical conduction of sound leading to conductive hearing loss, On;the contrary, there are two schools of thought when it come, to the issue of cpchlear involvement leading to sensorineural hearing loss (SNIIL) in chronic suppura the Otitis media. The present study was undertaken to find out whether a sensorineural component exists in hearing loss associated with chronic suppurative otitis media, A sample of 100 patients of unilateral chronic suppurative otitis media was selected for the Study and their bone conduction thresholds Mere analyzed in relation to the duration of disease using audiometric data. A 24 per cent incidence of sensoineural hearing loss was found in this series, garticularly involving the higher frequencies. Moreover, the incidence of sensorineural hearing loss progressively increased with the increase in duration of chonic suppurative Ouns meadia.

5O cases of carcinoma larynx were included in a prospective study to detect the incidence and pattern of nodal metastases (both clinical and occult) and to study the influence of certain characteristics of the primary tumor on the incidence of nodal metastases. In our study 66% (33 cases) of the lesions were transglottic as compared to 24% (12 cases) supraglottic and 10% (5 cases) glottic lesions. The most common age group affected in our study was 51-60 years comprising 50% of the cases. The most common symptoms were hoarseness, breathlessness and difficulty in swallowing. The incidence of clinically positive neck at the time of presentation was 42% while the incidence of occult nodal metastases was found to be 27.6%. The most common levels of lymph nodes involved in our study were levels II and III (87.5% cases). Multiple level lymph node involvement was seen in 71.4% of the eases at the time of presentation. A high incidence of cervical nodal metastases was associated with the following characteristics of the primary lesion-extralaryngeal spread, infiltrating or endophytic peripheral growth pattern, poor cellular differentiation and advanced T stage. In view of the high incidence of occult nodal metastases, use of selective lateral neck dissection is advocated in patients with a clinically negative neck at the-time of presentation (early glottic carcinomas being excluded).

Solitary thyroid nodule is a common clinical entity encountered by the otorhinolaryngologist and physcians. The optimum diagnostic strategy for the euthyroid patient with a soilitary thyroid nodule is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the solitary thyroid nodule. The present study was undertaken to evaluate the utility of FANC in the preoperative diagnosis of solitary thyroid nodule and to evaluate the efficacy of FNAC, VSG and RNS in differentiating between benign and malignant nodules. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 83.3% and specificity of 100% and is the single best investigation for preoperative evaluation of solitary thyroid nodules to differentiate between benign and malignant nodules.

Aspirated foreign bodies continue to present challenges to the otorhinolaryngologists-the major issues being accurate diagnosis and speedy and safe removal of the foreign bodies. Tracheobronchial foreign bodies are most common in the 1-3 year age group and are usually of vegetative origin. The most common signs and symptoms of tracheobronchial foreign bodies are cough, wheeze and decreased air entry on the affected side. Diagnostic bronchoscopy is recommended in all children presenting with a history of sudden onset of cough, choking spell, an unexplained acute wheeze, or a chronic pulmonary infection. The present study was undertaken to study the varied clinical presentations of tracheobronchial foreign bodies.