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Aim: To study the use of medial sural artery perforator (MSAP) free flap in head and neck reconstruction., Material and Method: This was a prospective study. The patients with cancers of head and neck underwent excision of tumor along with neck dissection, and MSAP free flap was used for reconstruction., Results: The free MSAP flaps were used in 30 patients to reconstruct head and neck soft tissue defects. There were sixteen male and six female patients with the median age of 40 years. The most common site of tumor resection was the tongue (14 cases), followed by buccal mucosa (12 cases), neck skin(2 cases), skin over parotid(1 case) and lip(1 case). Average flap size was 56 cm 2 . Thickness of the flap ranged from 4 to 8 mm. The length of the vascular pedicle ranged from 8 to 14 cm (12 cm mean) which provides sufficient length during vessel anastomosis. Arterial diameter ranged from 1.0 to 1.5 mm(Average - 1.25 mm) and venous diameter of both veins in pedicle ranged from 1.5 to 2.5 mm(Average - 2 mm) in size. Most flaps were based on two perforators. Primary closure was attained in 11 cases whereas 19 patients required split thickness skin graft(STSG). The average flap harvesting time was 45 min. Flap was failed in two cases., Conclusion: MSAP is good alternative to FRAFF in the reconstruction of defect after resection of head and neck cancer., Competing Interests: Disclosure of Potential Conflicts of InterestThere is no conflict of interest of any of author., (© 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.)

The objective of this study is to assess the concordance between Belfast 15/30 dB rule of thumb and subjective hearing benefit in middle ear reconstruction surgery. A total of 105 cases of chronic otitis media (COM) (both mucosal and squamosal type) with conductive hearing loss and who underwent middle ear reconstructive surgery during the study period from January 2019 to January 2022 were included. All cases were followed up at 6 week and at 3 months of postoperative duration for subjective assessment of hearing with questionnaire and pure tone audiometry as per standard of care and correlated with Belfast 15/30 dB rule of thumb. Concordance with Belfast rule of thumb was seen in 73.4% cases of both mucosal and squamosal type of COM. Belfast 15/30 dB rule of thumb is a valuable and useful tool to predict hearing benefit following middle ear reconstructive surgery, but, it suffers from the disadvantages of all or none phenomenon and it does not grade the level of hearing improvement. The prediction of postoperative subjective hearing with this Belfast rule of thumb is more reliable in mucosal type of COM than in squamosal type of COM., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interests., (© 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.)

Extensive composite defects involving the lip and cheek present difficult reconstructive challenges in view of functional recovery like oral competence, articulation, speech and mastication. This study presents our results of reconstructing through and through cheek defect with the use of free anterolateral thigh (ALT) flaps. All the patients with carcinoma of buccal mucosa and cheek who underwent through and through cheek resection and reconstructed with free composite pedalled anterolateral thigh flap between March 2019 to March 2020 were included in the study. We have assessed the post-operative functional outcome using University of Washington Quality of Life Questionnaire at the end of 12 months duration. We have excluded lost to follow-up and flap failure patients. Fifty patients were matched our inclusion criteria. Mean age was 43 years. Male to female ratio was 4.6:1. Stage 3 disease was in 8 patients and stage 4 disease was in 42 patients. Average size of the flap required was 15 × 7.5 cm, maximum was 24 × 11 cm. Oral competence was good in 74% patients. 80% patients were able to take semisolid diet, 8% were on liquid diet and 12% were dependent on RT feed. Average physical function (70.47 ± 19.09), social-emotional sub-score (81.72 ± 16.63) and composite scores (76.09 ± 17.86) were good and within acceptable range. Chewing (53 ± 29.29) and swallowing (64 ± 21.57) scored poorly among 12 domains. For extensive through and through cheek defects bipedelled ALT provides good functional outcome. In view of advance disease status extensive resection would be responsible for bone and mucosal loss affecting chewing and swallowing., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03416-3., Competing Interests: Conflict of interestThere is no conflict of interest of any of author., (© Association of Otolaryngologists of India 2022. 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.)

Through and through complex oro-mandibular defect usually involves buccal mucosa, mandibular segment, lip, and outer cheek skin. Reconstruction of such extensive three-dimensional defects pose a great challenge to reconstructive surgeons which requires use of two flaps. There are diverse options for such types of defects like use two pedicled flaps, one free flap, one pedicled flap or use of two free flaps. Amongst them the use of dual free flaps is ideal for the reconstruction. Commonly used dual free flaps are free fibula osteocutaneous flap for mandible, buccal mucosal defect and free radial artery flap or antero-lateral flap for cheek defect. The major disadvantages of using these two free flaps include two different sites for flap harvest, more time for harvesting and increased overall surgery time. We present our experience of reconstruction of large oro-mandibular defect using free osteo-cutaneous fibula flap and lateral sural artery free flap from single limb in six patients between January 2019 and December 2020. Minimum follow up was 6 months., Competing Interests: Conflict of interestThere is no conflict of interest of any of author., (© Association of Otolaryngologists of India 2022, 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.)

Deviated nasal septum is one of the most commonly encountered nasal anatomical abnormalities. Various studies showed that deviated nasal septum results in the osteo-meatal complex disease and compensatory turbinate hypertrophy. But only a few studies described the association between type and degree of angle of deviated nasal septum and measured the angle of septal deviation and explore its effect in causation of nasal symptomatology. Hence, this study was undertaken with the aim to study the relation between type and degree of septal deviation with nasal symptomatology and to measure the degree of septal deviation. This was an observational study and data collection was done from August 2017 to August 2019. A total 52 patients with symptomatic deviated nasal septum were studied. Higher septal deviation caused symptoms in 73% of cases and severe degree of angle of septal deviation caused symptoms in 63% of cases. High and severe deviated nasal are more associated with nasal symptoms. Therefore, we could derive a correlation between the cases with higher septal deviation and incidence of nasal symptoms., Competing Interests: Conflict of interestAuthors declare no conflict of interest., (© Association of Otolaryngologists of India 2021.)

(1) Defining a protocol for management of patients with severe temporomandibular joint ankylosis. (2) Review the results of use of GORE-TEX as an interpositional material in gap arthroplasty. All cases which were treated with surgical intervention for severe TMJ Ankylosis with use of GORE-TEX as an interpositional material have been included. Amongst 40 patients, 11 were male and 29 were female with age group ranging from 4 to 36 years. 22 patients had bilateral ankylosis and 18 patients had unilateral ankylosis needing unilateral condylectomy. In all the patients GORE-TEX was used as an inter-positional material to form a pseudo joint. Postoperative mouth opening was around 3 fingers (3-3.5 cm) for period of 2 years i.e. last follow up. Migration or extrusion of implant was not seen in any of our cases. Use of GORE-TEX as an inter-positional material can prevent recurrences with good restoration of the physiological joint and occlusion., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

Endoscopic dacryocystorhinostomy (DCR) is an effective surgical procedure to treat nasolacrimal duct obstruction. This study was conducted with an aim of comparing the success rate between use of stent and without use of stent in endoscopic DCR. A prospective randomized study was conducted. Total 50 cases with signs of nasolacrimal duct blockage were included. The cases were randomly divided in two groups with 25 cases in each group. Group A cases underwent endoscopic DCR with stent and group B without stent. The follow up was till 12th week. Both subjective and objective outcomes were noted. By 12th week, only 8% cases had no relief of symptoms in group A while 92% cases of group A and all cases of group B had complete relief of symptoms. In objective outcome, by the 12th week, in group A 92% cases had full patency while in group B 100% cases had full patency. Overall complications in postoperative period were seen in 28% patients in group A and 12% patients in group B. In this study the surgical results of endoscopic DCR with or without stent came almost equal with no statistical difference in the success rate between stent group and non-stent group. Now that Endoscopic DCR without stent is equally effective and reduces cost, we recommend that the endoscopic DCR without stent should be preferred., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2017.)

To assess the quality of life in head and neck cancer patients and the various factors which affect the quality of life in head and neck cancer patients was the main aim of the study. A prospective longitudinal study with a sample size of 130 patients was done within the time period of one and a half years. Patients with biopsy proven squamous cell carcinoma of the head and neck were treated as per their treatment protocol either by combined modality or single modality. Follow up at the completion of treatment was done and the quality of life questionnaire was filled out. QoL was assessed pre-treatment and at 4 times at different stages of follow up period. Demographic data was also taken into consideration for comparison which showed that head and neck cancer is more common in the males (80%) between the age group of 35-50 years, chronic tobacco chewers (45%) with most common site of cancer being the oral cavity (61%). Majority of the patients presented at Stage IV of their disease (35%) with largest HRQoL changes seen within the first three months after commencement of treatment. The most debilitating modality of treatment was Surgery + CTRT. Detailed assessment of the various factors which hamper the QoL in head and neck cancer patients should be done by which we can provide quality care and a completely new view into the health care experience and improving patient satisfaction., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2019.)

Head and neck cancers together (oral cavity, pharynx and larynx) are sixth commonest worldwide and are the commonest cancers in developing countries. The Cancer Project was started in Kheda/Anand, Gujarat, a harvest land of tobacco. The objective of this programme was to indoctrinate the most vulnerable and the least tended upon; the basics of head and neck cancers via the medium of their own kins. Voluntary village health workers were educated and trained to pick up the early signs of head and neck cancers. Oral self examination was taught to them and they went to peripheral villages to screen the population. They would refer suspicious cases to tertiary healthcare centre. The population was enlightened upon the basics of preventable measures, treatment options and rehabilitation facilities for head and neck cancer patients. Knowledge, attitude and practice analysis was done in the population which showed widespread disbelief and false practices. A population of 26,10,432 was surveyed in 1862 villages of which 10,522 (1.1%) individuals successfully quit the habit. The minimally educated workers referred 3309 suspicious individuals to higher centre of which 1890 (57.11%) tested positive for cancer. A lot of resource is put in research and development of rapid diagnosis and complete cure; however such a minimally costing program may help the most in primordial, primary and secondary level of prevention. Such programs should be advocated on the global platform on lines of Breast Self Examination., Competing Interests: Compliance with Ethical StandardsThe authors declare they have no conflict of interest.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research and ethics committee and with the 1964 Helsinki declaration and its later amendments.”Informed consent was obtained from all individual participants included in the study.

To compare the outcome of type I tympanoplasty with cortical mastoidectomy in chronic otitis media active mucosal disease (wet ear) versus chronic otitis media inactive mucosal disease (dry ear). An observational analytic study was conducted and data collection was done from August 2014 to August 2016. All patients of chronic otitis media with mucosal disease were divided into two groups, one with active disease (group A) and another with inactive disease (group B). The outcome was studied in the form of graft take up rate. Total 103 patients were studied, group A (wet ear) had 67 and group B (dry ear) had 36 patients. Graft take up rate was 94% in wet ear and 100% in dry ear and p value was 0.2. There was no statistically significant difference found between the two groups.

Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis.

Eustachian tube dysfunction (ETD) has a role in chronic otitis media (COM) is a well known fact and number of modalities have come up for its assessment-slow motion dynamic videoendoscopy (SMDV) being the latest. (i) To find prevalence of ETD in COM and (ii) to check the efficacy of SMDV in detecting dysfunction as compared to gold standard tympaometry (TYM). It's a prospective analytical study with total of 100 patients of chronic otitis media, hence 200 ears were tested for ETD by TYM and SMDV. Prevalence of ETD was noted as 35.5 % in COM whereas the two testing modalities TYM versus SMDV showed agreement in 161 cases out of the 200 ears giving a moderate agreement of statistical significance (Kappa test) suggesting SMDV to be included in standard of protocol when assessing ETD along with TYM.

Unlabelled: Deafness is commonest curable childhood handicap. Most remedies and programmes don't address this issue at childhood level leading to detrimental impact on development of newborns. Aims and objectives are (A) screen all newborns for deafness and detect prevalence of deafness in children less than 2 years of age. and (B) assess efficacy of multi-staged OAE/ABR protocol for hearing screening., Methodology: Non-randomized, prospective study from August 2008 to August 2011. All infants underwent a series of oto-acoustic emission (OAE) and final confirmatory auditory brainstem evoked response (ABR) audiometry. Finally, out of 1,101 children, 1,069 children passed the test while 12 children had impaired hearing after final testing, confirmed by ABR. Positive predictive value of OAE after multiple test increased to 100 %. OAE-ABR test series is effective in screening neonates and multiple tests reduce economic burden. High risk screening will miss nearly 50 % deaf children, thus universal screening is indispensable in picking early deafness.

Introduction: Appendiceal tumors represent a subset of colonic neoplasms that frequently defy early diagnosis only to present at advanced stage with peritoneal metastasis. Data on early detection by colonoscopy is limited to case reports or series. The aim of this study is to determine the diagnostic yield of colonoscopy in detecting appendiceal lesions in patients with appendiceal adenocarcinoma and pseudomyxoma peritonei., Methods: We reviewed clinicopathologic data on 121 consecutive patients with histologically confirmed appendiceal adenocarcinoma with pseudomyxoma peritonei presenting to our institution for intraperitoneal hyperthermic chemotherapy (IPHC) and cytoreductive surgery between February, 1993 and August, 2007, focusing on the colonoscopy findings., Results: Preoperative colonoscopic data were available on 64 patients (average age = 51; 52 for IPHC patients). Abnormal findings included seven patients with appendiceal lesions (11%), 12 patients with cecal abnormalities (19%), and 28 patients with polyps (44%). Twenty-three patients (36%) had a normal colonoscopy. Malignancy was documented in two of the 64 (3.1%) patients on preoperative colonoscopy biopsies., Conclusions: Appendiceal abnormalities are infrequently seen on colonoscopy and rarely yield a diagnostic biopsy in patients with appendiceal carcinoma. We found that nearly 42% of patients with carcinoma of the appendix have synchronous colonic polyps, a much higher prevalence than would be expected, supporting a role for a perioperative colonoscopy.

Dermatofibrosarcoma protuberance of head and neck is a rare neoplasm and accounts for less than one percent of Head and Neck Neoplasm. The objective of this report is to understand etiology, presentation, histopathologic identification and treatment option for this tumour. The goal of current report is to acquaint the clinician with presentation and treatment option for this disease.