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Introduction  Degenerative changes in the otolithic organs have been theorized to be caused by the mechanical obstruction to endolymphatic flow, possibly resulting in endolymphatic hydrops (ELH). Otolin-1 is an otoconial matrix protein that crosses the blood labyrinth barrier and has been found in the serum of healthy and diseased patients. Objective  To measure the serum levels of Otolin-1 in Meniere disease (MD) patients and compared them with the healthy individuals. Methods  This pilot, cross-sectional study was performed at our tertiary care referral center to compare the serum Otolin-1 levels of healthy individuals with those of MD patients. The blood samples were obtained during patients' visit to the vertigo clinic following remission of an acute episode. The data was analyzed using the Stata/SE version 12.0 (StataCorp. College Station, TX, USA). Comparison between the serum Otolin-1 levels in the two groups was performed using the unpaired t -test. A p -value of 0.05 was considered to be statistically significant. Results  The participants were divided into two groups, with 31 MD patients, and 30 age and gender-matched members of the control group. The serum levels of Otolin-1 in MD patients (247.6, ± 44.2 pg/ml) were not found to be significantly different from those of the control group (236.2, ± 43.5 pg/ml) ( p  = 0.31). Conclusion  The current study reveals that the serum levels of Otolin-1 are not significantly different between the patients with MD in the interictal phase and the control group's healthy ones., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

We conducted this study to determine if serum galactomannan (GM) can be used as a marker to implicate the invasiveness of allergic fungal rhinosinusitis (AFRS), and correlate this value with the aggressiveness of disease documented via computed tomography (CT). All paranasal CT scans done for AFRS patients prospectively over a five-year period (2015-2019) were included. An indigenous 20-point score was used to document the extent of bone erosion seen on CT, wherein a higher score meant a greater extent of bone erosion. It was then correlated with serum GM scores. The median CT scores of galactomannan-positive (GM+) patients were compared with the median CT scores of galactomannan-negative (GM-) patients 3 using Mann-Whitney U test. The patients were divided into five groups based on the extent of disease-No bone erosion, erosion of only sinus wall/orbit, 3 erosion of orbit and skull base, erosion of only skull base and lateral extension of disease into infratemporal fossa (ITF). Subgroup analysis was conducted over mean GM values in these groups using ANOVA test. p -value < 0.05 was considered significant. Statistical analysis was performed using SPSS version 25.0. A total of 92 patients were included (56 males, 36 females). No statistically significant difference was found ( p -value = 0.42) between the CT scores of galactomannan-positive (GM+) group and galactomannan-negative (GM-) group. The mean GM scores amongst the five sub-groups did not show a statistically significant difference. Serum galactomannan values correlate poorly with aggressiveness of disease quantified on non-contrast CT of paranasal sinuses., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest to disclose., (© 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.)

Vitamin D is thought to play an inflammatory modulatory role in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP) & it also affects the severity of inflammation so the study was focused on the evaluation of serum vitamin D & interleukins in CRSwNP. The prospective study was conducted on clinic-radiological confirmed cases. The patients were not operated prior, clubbed under primary nasal polyposis (PNP) group and the patients were operated prior, clubbed under recurrent nasal polyposis (RNP) group. The subjective and objective severity of the disease was assessed by sino-nasal outcome score (SNOT 22) & NCCT PNS & orbit. Serum levels of cytokines (IL4, IL 5, and IL 13) were quantified using the ELISA method using the Human Interleukin antibody coated ELISA kit. Measurement of vitamin D was done by using recombinant ruthenium-labelled VDBP. There was a significant difference in Vitamin D, AEC, IL 4, IL 5, IL 13 levels in the disease groups compared to control group. Low vitamin D, high SNOT & high absolute eosinophil count (AEC) count was noticed in both disease groups. Vitamin D may play a significant role in nasal polyposis formation. For the establishment of interaction, a community based larger study is required as the prevalence of low vitamin D level is high in Indian population., (© Association of Otolaryngologists of India 2022.)

We plan to evaluate the various variables associated with the complications of thyroidectomy performed at our department in the last 5 years. Medical records of the patients who underwent thyroidectomy during 2014-2018 were collected. Complications of hypocalcemia and recurrent laryngeal nerve palsy were analysed in terms of the demography, cytopathology and the extent of surgery. Student's t -test, Mann-Whitney U -test, Fisher exact test and chi square test were applied to look for any significant associations. P value < 0.05 was considered significant. 123 patients were analysed (87 females, 38 males). Mean age was 38.3 years (range 11-71 years). Most common cytopathology was papillary carcinoma thyroid (Bethesda VI) - 43/123 (35%). 107 of these 123 patients underwent primary surgery, 10 underwent revision surgery while 6 underwent completion thyroidectomy. Seven patients incurred RLN palsy out of which 3 were temporary. RLN palsy was seen in only malignant cases ( p  < 0.05). Incidence was higher in T4a stage ( p  < 0.05). However, it had no association with a simultaneous central or lateral neck dissection. Hypocalcemia was seen in 22 patients (17.8%), out of whom 9 patients developed permanent hypocalcemia. It was seen significantly higher in patients undergoing central neck dissection ( p  < 0.05) and in malignant thyroid lesions ( p  < 0.05). Gender, age and the cytopathology had no bearing on RLN palsy and hypoparathyroidism. Malignant thyroid lesions had a significantly higher incidence of RLN palsy and hypoparathyroidism. A thorough anatomical knowledge can reduce the incidence of these complications., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

The past decade has witnessed a change in landscape of cancer management with the advent of precision oncology. Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and have played an important role in improving patient survival. While the patients are living longer, treatment with ICIs are sometimes associated with adverse effects, some of which could be fatal. Radiologists can play a crucial role by early identification of some of these adverse effects during restaging scans. Our paper focuses on the imaging features of commonly occurring ICI toxicities based on organ system., Competing Interests: None., (© 2022 The Authors.)

Purpose: To evaluate and compare the prevalence of high-risk HPV and low-risk HPV types in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and healthy controls., Materials and Methods: A prospective cohort study was conducted in a tertiary care hospital on the patients of CRSwNP undergoing surgical management. All patients underwent preoperative endoscopic evaluation and radiological assessment using NCCT of the nose and paranasal sinuses. The severity of the disease was graded using the Lund-Mackay score on NCCT. All patients underwent endoscopic polypectomy and the sample of tissues was sent for HPV DNA detection using Hybrid Capture II® technique. The clinicopathological characteristics of HPV positive and negative patients were compared., Results: Sixty cases and 20 controls were included in the study. All controls were negative for HPV DNA. 27 patients (45%) had the presence of HPV DNA, out of which 23 had only LR-HPV and 1 had only HR-HPV types. Three patients had both HR-HPV and LR-HPV subtypes. There was a significant difference between the cases and controls for the presence of HPV DNA (p < 0.001). However, the patients with HPV-positive DNA in the nasal specimen did not differ significantly from HPV-negative patients in age, gender, or severity of the disease., Conclusions: Human papillomaviruses may play a significant role in the etiopathogenesis of CRSwNP, however, do not impact the degree of sinus involvement., (Copyright © 2021. Published by Elsevier Inc.)

Objective: Pediatric tracheostomy is a challenge in otolaryngology practice and it is associated with greater morbidity and mortality than in adults; hence, constant vigilance by the designated family caregiver is critical. This study was designed to assess the impact of on quality of life of caregivers in a homecare setting as a result of the presence of child with a tracheostomy., Methods: This was a combined retrospective and prospective cohort study with caregivers of children younger than 16 years who had undergone a tracheostomy, had been discharged home with a tracheostomy tube and completed 6 months of domiciliary tracheostomy care. The consenting primary caregivers were assessed for their quality of life based on the PedsQL v 4.0 questionnaires across various domains., Results: We identified the primary caregivers of 85 children who had undergone a tracheostomy during the study period. The children's median age was 3.5 years (range, 9 months to 14 years). The mean caregiver health-related quality of life (HRQOL) score was 59.3, the mean family functioning score was 62.8, and the mean total family impact score was 54.7 with relative deficits seen in caregiver's social functioning (56.9) and emotional functioning (53.2). Good or average quality of physical and social function was seen among 74 % and 65 % of caregivers respectively while only 55 % were reported having good or average emotional function. Emotional disturbance, interfering with everyday family activities, and sleep disturbance were the major concerns among caregivers., Conclusion: The biopsychosocial consequences of caring for a child with a tracheostomy are profound for the family, affecting the quality of life of caregivers and adding to the emotional and social burden of the child's family., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Recurrent respiratory papillomatosis (RRP) is known for its recurrent relapse despite various surgical and non-surgical treatments. Vascular Endothelial growth factor (VEGF) receptor expression on tissue is reported to be raised in RRP, and anti-VEGF targeted treatment is being explored to decrease recurrences. This study aims to identify the patients most suitable for systemic anti-VEGF therapy., Methods: The study design was a prospective cohort evaluation. The study group included all consecutive cases of RP treated surgically from November 2016-June 2019. Tissue receptor expression and serum levels of VEGF were assessed by immunohistochemistry and ELISA assay. Control samples for normal levels obtained by serum samples of healthy individuals and tissue samples obtained from healthy non-inflamed peripheral tissue of laryngectomy specimens. The tissue expression and serum levels of VEGF were compared with various disease-related factors of RP., Results: 32 cases of RRPs were included in the study with a median age of 20.85 years (range: 3-60 years). The glottis was involved in all patients and tracheobronchial involvement was seen among 6 patients (18.75%). The systemic and tissue expression of VEGF-A was significantly higher among cases than controls (p= <0.001). The serum level of VEGF-A was significantly higher among cases with higher Derkay's score (>20) (p = 0.02) and tissue expression of VEGF-A was significantly higher in tracheobronchial RRP (p = 0.04)., Conclusion: Patients of RP with tracheobronchial involvement and high Derkay's score with strong tissue receptor expression & high serum level of VEGF can be identified as the patients wherein anti-VEGF monoclonal antibody treatment is more likely to be effective and merits further investigation to prove this., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Digastric ridge (DR) is an important landmark to locate facial nerve (FN) and sigmoid sinus for mastoid surgeries and transmastoid approaches. We aim to look for the effect of temporal bone pneumatization on the morphometry of the DR and its relation to the adjoining structures., Methods: Temporal bones were harvested from unclaimed cadavers after the approval of the ethical committee. The dissection of the temporal bones was performed under a microscope, and the length of the DR and the distance between the mastoid segment of the FN and the anterior end of DR (FN-DR distance) were measured using a digital caliper. Stata version 14.0 was used to perform the statistical calculations., Results: Ninety-three temporal bones were microdissected (right:left = 47:46; well pneumatized:poorly pneumatized = 58:35). Mean length of the DR was 17.1 mm and was significantly longer in well-pneumatized bones ( P = .0000). The mean distance between the anterior end of the digastric ridge and the mastoid part of the facial nerve was 4 mm. The distance was significantly more in well-pneumatized bones., Conclusion: Prominence and the length of the DR, as well as the FN-DR distance, are significantly more in well-pneumatized bones compared to poorly pneumatized bones. This finding has potential surgical implications with reduced risk of injury to the FN resulting from a conspicuous DR in well-pneumatized bones.

Objectives: This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals., Method: This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18-75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant., Results: A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259-981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189-370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000)., Conclusion: The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo.

Introduction  Successful cochlear implantation requires an appropriate insertion depth of the electrode, which depends on cochlear duct length CDL). The CDL can vary due to ethnic factors. Objective  The objective of the current study was to determine the CDL in an Indian adult cadaveric population. Methods  The present was a cadaveric study using the temporal bones obtained after permission of the Institutional Review Board. The temporal bones were subjected to high-resolution computed tomography (HRCT), and the double oblique reformatted CT images were reconstructed through the basal turn of the cochlea. The reformatted images were then viewed in the minimum-intensity projection (minIP) mode, and the 'A' value (the diameter of the basal turn of the cochlea) was calculated. The CDL was then measured using the formula CDL = 4.16A - 4 (Alexiades et al). The data analysis was performed using the Microsoft Excel software, version 2016. Results  A total of 51 temporal bones were included for imaging analysis. The CDL varied from 27.6 mm to 33.4 mm, with a mean length of 30.7 mm. There was no statistically significant difference between the two sides. Conclusion  The CDL can be calculated with preoperative high-resolution CT, and can provide a roadmap for effective cochlear implant electrode insertion. The population-based anatomical variability needs to be taken into account to offer the most efficient and least traumatic insertion of the electrode., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare.

Introduction: Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles. Incudostapedial joint (ISJ) is conventionally considered to be at right angle., Objective: We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same., Methods: In a cadaveric study comprising of 47 human temporal bones, canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact. The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone. The data analysis was performed using statistical software Stata version 12.0., Results: The mean ISJ angle for the 47 bones was 90.5 0 (SD-15 0 ; range:54 0 -122 0 ). The mean angle in well pneumatized bones was 93.7 0 (SD-16.5; Range:54°-122 0 ) and in sclerotic mastoids was 88.7 0 (SD-14; Range:68°-118 0 ). The difference in the ISJ angle in these two conditions was not statistically significant ( p =  0.27). The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ (111.4 0 {SD-8.8; range:100.3 0 -121.9 0 }; p  = 0.0001) and in the cases with an 'adherent/tilted morphology' of the stapes suprastructure with the promontory (mean-95.8 0 {SD-13.8; range:70.7 0 - 120.4 0 ); p - <0.00001)., Conclusion: The ISJ angle shows considerable variations. This variability needs to be taken into account when undertaking middle ear reconstructive procedures, specifically the ones involving the stapes footplate. The mastoid pneumatization does not appear to have an impact on the ISJ angle., (© 2019 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.)

Objectives: To establish a new surgically relevant classification system of the anatomic variations of the temporal bone tegmen plate as well as to perform a comparative analysis, with respect to the pneumatization patterns in the cadaveric temporal bones., Materials and Methods: Microdissection of the human cadaveric temporal bones was performed after obtaining ethical approval from the Institutional Ethical Committee (F.8-522/A-522/2017/RS). The pneumatization pattern of the temporal bones was noted as "under-pneumatized" or "well-pneumatized." The tegmen mastoid (TM) was classified into two grades as per the position of the tegmen plate and the visibility of the superior semicircular canal (SSCC) and the aditus. The latter two structures were well visualized in Grade A and poorly visualized in Grade B. The data were analyzed using Stata 14.0 (Stata Corp, 4905, Lakway drive, College Station, Texas, USA)., Results: Ninety-three temporal bones were dissected under microscope. Fifty-eight bones were well-pneumatized and 35 were under-pneumatized. The tegmen plates were classified as Grade-A in 49 bones (well-pneumatized -37 and under-pneumatized -12), and as Grade-B in 44 bones (well-pneumatized-21, poorly-pneumatized-23). Grade-A classification was significantly more common in well-pneumatized temporal bones, while Grade-B was more common in under-pneumatized bones (p=0.0057)., Conclusion: We propose a surgically relevant classification for TM positioning. A well-pneumatized temporal bone is associated with a significantly higher position of the tegmen plate (Grade-A TM).

The increase awareness and advent of anti-tuberculosis therapy led to decline in tuberculosis. Now a resurgence of tuberculosis is with immunosuppression and with resistant strains. The detection rate of extrapulmonary is increased with the advent of newer modalities of detection, imaging, and better testing. This case series documents our experience with seven cases of primary spheno-petro-clival lesion and details of the clinical and radiological presentations of these patients. Intraoperative obtained tissue was send for histopathological and microbiological evaluation. The most common symptoms were headache and nasal discharge. The final diagnosis of spheno-petro-clival tuberculosis was confirmed in all cases with histopathology and by culture post-operatively. Skull base tuberculosis is relative rare entity in past because of late occurrence of specific symptom, incomplete radiological evaluation and it may present as neck swelling by travelling through various neck spaces. (1) Tubercular infection should be considered as differential in skull base lesion as pickup rate is increasing with advancement in technology. (2) Two of our cases had retropharyngeal abscess have focus in skull base bone. The skull base, hence, may be one of foci in undetermined sites of tuberculous infections and should be searched for., (© Association of Otolaryngologists of India 2017.)

Introduction  Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application. Objective  We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of the mastoid and to the level of mastoid pneumatization. Methods  A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCC were exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades. Results  Grade I had the best exposure of the presigmoid dura and of the PSCC, while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and higher mastoid volumes compared with grades II and III. Conclusions  The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.

The stapes surgery has evolved through different eras of technical and technological development. The current standard of care is creating a stapedotomy with piston placement, and both these aspects have multiple variations and show well-established technological advances. The conventional technique has been fairly standardized,and it offers gratifying results to both the surgeon and the patient. To overcome certain procedural risks and potential complications, the reversal of steps technique was developed and streamlined by Ugo Fisch in the early 1980s. Since its beginning, the technique has been adopted by various centers, and surgical outcomes have been demonstrated to be at par with the conventional technique, with a reduced risk of complications. The aim of the present review is to detail the various surgical nuances and outcomes of this particular technique in a comprehensive narrative manner.

Objective: To recount experience with cerebrospinal fluid otorrhoea and temporal bone meningoencephalocele repair in a tertiary care hospital., Method: A retrospective review was conducted of 16 cerebrospinal fluid otorrhoea and meningoencephalic herniation patients managed surgically from 1991 to 2016., Results: Aetiology was: congenital (n = 3), post-traumatic (n = 2), spontaneous (n = 1) or post-mastoidectomy (n = 10). Surgical repair was undertaken by combined middle cranial fossa and transmastoid approach in 3 patients, transmastoid approach in 2, oval window plugging in 1, and subtotal petrosectomy with middle-ear obliteration in 10. All patients had successful long-term outcomes, except one, who experienced recurrence after primary stage oval window plugging, but has been recurrence-free after second-stage subtotal petrosectomy with middle-ear obliteration., Conclusion: Dural injury or exposure in mastoidectomy may lead to cerebrospinal fluid otorrhoea or meningoencephalic herniation years later. Congenital, spontaneous and traumatic temporal bone defects may present similarly. Middle cranial fossa dural repair, transmastoid multilayer closure and subtotal petrosectomy with middle-ear obliteration were successful procedures. Subtotal petrosectomy with middle-ear obliteration offers advantages over middle cranial fossa dural repair alone; soft tissue closure is more robust and is preferred in situations where hearing preservation is not a priority.

Background: The arcuate eminence (AE) is a bony prominence on the middle fossa plate of the temporal bone, hypothesized to be variably associated with superior semicircular canal (SSC) relief, temporal lobe sulcus, and subjacent air cells. We present various morphometric parameters of the AE, as seen using a middle fossa approach., Materials and Methods: The study used 18 formalin-preserved cadaveric human temporal bones. Various morphological and morphometric parameters pertaining to topographic orientation of the AE in relation to surrounding landmarks used in a middle mossa approach were noted, before and after microdissection of the AE under a Leica M320 F12 microscope, using otologic microdrills and suction irrigation. The morphometric parameters were analyzed using ImageJ 1.46r software., Results: The overall incidence of AE was 83% (n = 15/18). The most common shape and pattern noted were linear (53.3%, 8/15) and dual arc (46.7%, 7/15), respectively. Mean angle between the AE and SSC was 19°, with a standard deviation of 15° and a range of 2-49°. The AE overlapped the SSC in 40% (6/15) of bones, and did not correspond to the SSC in 7% of cases. A partially overlapping positional correspondence was noted in 53.3% (8/15)., Conclusion: When present, the AE corresponds to the SSC in 40% of cases, but it can serve as a rough guide to the SSC in up to 93% of cases. Surgeons need to be familiar with the varying morphology of AEs in order to execute a rapid and safe dissection during middle fossa approaches., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Primary small cell neuroendocrine carcinoma is uncommon in head and neck region, with occasional cases in nasopharynx. Distinction from other round cell tumors is imperative to ensure optimal patient management. We present a case of a 30-year-old woman who presented with a rapidly growing nasopharyngeal mass., Competing Interests: The authors declare that they have no conflict of interest.This article is a case report and does not contain any studies with human participants or animals performed by any of the authors.Informed consent was obtained from the patient included in the study.

NUT midline carcinomas (NMCs) are rare, poorly differentiated tumors with aggressive biological behavior and a characteristic molecular signature. Availability of NUT antibody has facilitated diagnosis of NMC without molecular testing. We report a series of head and neck NMCs diagnosed using NUT IHC at our institute, including one case with an unusual course. Immunohistochemistry for NUT was performed in nasal and sinonasal tumors with diagnoses of undifferentiated carcinoma, poorly differentiated squamous cell carcinoma and malignant neoplasm, not otherwise specified, to identify cases of NMC. Clinicopathological features were reviewed. Five cases of NMC were identified, accounting for 9.6% of poorly differentiated/undifferentiated carcinomas of the sinonasal region. These patients had a sex ratio of 2:3, and ranged in age from of 10 to 31 years (mean: 25.2 years). Patient 4 had previously been diagnosed with basal cell carcinoma arising in left nasolacrimal duct, and inverted papilloma of nasal cavity. She presented to us with a left lacrimal fossa mass extending into nasal cavity, which was diagnosed as NMC. NMC is a rare neoplasm, the awareness of which is imperative for pathologists to identify cases in which NUT IHC should be ordered. NUT IHC should be performed in all cases of a poorly differentiated carcinoma, particularly those with foci of squamous differentiation, irrespective of patient age and unusual tumor location, as seen in one of our cases. Although considered a highly aggressive and lethal neoplasm, NMC can have a more prolonged clinical course on occasion.

Summary: Inflammatory myofibroblastic tumours (IMTs) are rare and clinically benign in childhood, and malignant in adults. The aetiology of IMTs is not clear, and recent studies report it as true neoplasm rather than a reactive or inflammatory lesion. IMTs can involve any part of the body, but are usually common in lungs. These are rarely seen in adults and tracheal involvement is also rare in both adults and children. We describe an 18-year-old woman who presented with respiratory difficulty to the emergency department. On clinical examination, the patient had complete absence of breath sounds on the right side of the chest. CT of the chest and virtual bronchoscopy revealed a polypoidal soft tissue mass lesion involving the carina with occlusion of right main bronchus. Endoscopic-assisted resection was performed under general anaesthesia and the final pathological diagnosis was tracheal IMT., (Copyright © 2018 Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.)

Tuberculosis involving mastoid and ear is an uncommon entity presenting with myriads of non-specific features and difficult to diagnose, being a paucibacillary condition. The involvement of otomastoid compartment is hypothesised to be of haematogenous origin. Rarely it can spread directly via tympanic membrane perforation or via reflux through eustachian tube. The usual picture of presentation tends to be one of indolent ear infection not responsive to usual antibiotic treatment and symptomatology being out of proportion to examination findings. We present a case of aural tuberculosis presenting with zygomatic and Bezold abscess without other symptoms, and the usefulness of GeneXpert test in mycobacterial detection in such paucibacillary conditions., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.