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Thyroid swelling is the most common swelling among the endocrine disorder. It can affect any age group. USG neck will help to diagnose the solid and cystic lesions. The treatment is surgical excision. FNAC is a good diagnostic tool to minimize the incidence of thyroidectomy. FNAC is cost effective, reliable and OPD procedure. Final diagnosis can only be made by HPE postoperatively. The aim of this study is to find out the relative occurrence of various pathological conditions presenting as midline thyroid swellings and clinicopathological and radiological examination of the thyroid swellings. A one and half year prospective study which was carried out from October 2016 to April 2018 in ENT department of MMIMSR, Mullana, Ambala. Informed written consent was taken from all the patients. A complete clinical, radiological, cytological an HP Examination was done. Total 50 patients were included in the study. Complete clinical data of the patient was gathered from medical records. The maximum number of patients in present study was found in an age group of 31–40 years (34%). There was female predominance with female to male ratio of 7.3:1. Most of the patients belonged to rural background i.e. 42 (84%) patients. Most of the patients present with Left sided neck swelling i.e. 18 (36%) patients. Ultrasound revealed that non neoplastic lesions were present in 44 (88%) patients and 6 (12%) patients had neoplastic lesions. FNAC showed that non neoplastic lesions were present in 38 (76%) patients and 12 (24%) patients had neoplastic lesions. On HPE, non neoplastic and neoplastic lesions were present in 36 (72%) and 14 (28%) patients respectively. Colloid goiter was the most common among the non neoplastic lesions in 29 (58%) patients. Papillary carcinoma was the most common malignant disease in 4 (8%) patients. Thyroid swelling was most commonly seen during the 3rd and 4th decade of life, with a female preponderance. Most common benign thyroid swelling is Colloid goiter and papillary carcinoma was the most common malignant disease. Histopathology is considered as a gold standard.

Tubo-tympanic disease of middle ear cleft can temporarily detoriate the bone conduction threshold specially in higher frequency in long standing cases. It mainly affects the inertial ossicular component of the bone conduction mechanism. (1) Study the effect of tubotympanic disease on bone conduction threshold (SN loss). (2) Study the duration of the disease on bone conduction threshold. 84 cases of tubotympanic disease were taken for the study. There pre-operative PTA was done and effect of the disease on the bone conduction threshold was noted. Results were analyzed by using analysis of variance. The significance level α was taken 0.05 as at marginally significant, 0.01 significant and 0.001 as highly significant. The bone conduction at all frequencies increased significantly P 21 years conductive subjects were 19 (63.33%) and subjects with mixed hearing loss increased to 5 (33.33%) cases. The average hearing loss and the average bone conduction threshold increases as the duration of disease increases. In patients of safe CSOM who have poor BCT, it is the higher frequencies which are more affected.

Cysticercosis is a major public health problem especially in developing countries like ours. Disease can be prevented by increasing the public awareness about personal hygiene and sanitation. The disease commonly affects the central nervous system and the condition is referred to as neurocysticercosis. Neurocysticercosis is probably is the commonest parasitic infestation of the central nervous system (CNS). Although the extracranial involvement is exceedingly rare. The head and neck regions commonly affected are tongue, sternocleidomastoid muscle, masseter muscle and strap muscles of the neck. Isolated cases of cysticercosis have been reported in the literature in head and neck region. We are reporting the case series of seven cases of extracranial cysticercosis presenting in different parts of head neck region. Two cases presented with a tongue nodule, two cases in the region of masseter muscle, one case in the pre-maxillary region and one in the sternocleidomastiod muscle in the neck. All cases were dealt with a clinical suspicion of cysticercosis as the condition is endemic in our region. The empirical treatment was started in all the cases after demonstration of cyst on ultrasonography. The cases responded to the oral albendazole combined with corticosteroid therapy. As the disease is a common entity in our country all cases presenting with firm, long standing, single swelling in the head neck region should be dealt with suspicion of cysticercosis. Early diagnosis and treatment can prevent the hazardous intracranial complications and mortality.

Thyroglossal cyst is the most common congenital anterior neck swelling in childhood. Commonly present as painless swelling in the 2nd decade of life but the cases are reported in the elderly age group also. It represents the persistent epithelial tract from the foramen cecum to the thyroid gland. Clinically can be diagnosed and can be differentiated with other mid-line swelling by movement with the protusion of tongue. It is usually related to the hyoid bone and may be supra-hyoid, infra-hyoid, lower part of the midline or rarely lingual in position. Ultrasonography is the investigation of choice for this cystic condition. It is safe, economical and easily available investigation among all the radiological study. MRI is helpful to diagnose cervical extension and lingual cyst. Inspite of close relation to the laryngeal structure it rarely present as laryngeal mass and causes stridor or sleep apnea as in our case. Classic Sistrunk procedure is the treatment of choice for the condition. Endoscopic CO2 Laser is useful in situation where only intraoral cyst present without cervical extension. Marsupialization is reserved for lingual cyst especially in Neonate. We are reporting this case which was present in the elderly and reported with long standing anterior neck swelling with inspiratory stridor on lying down position.

Inverted papilloma (IP) is a tumor most commonly originates from lateral wall of nose and benign in nature. Sphenoid sinus is a rare site of origin and involvement. Malignant changes are the rare possibility in the IP. In this case report we reported a rare case of squamous cell carcinoma in back ground of inverted papilloma of sphenoid sinus.

Allergic Rhinitis is one of the gift of modern era. Condition is involving wide range of age group starting from children to old age people. In spite of latest diagnostic facility and advanced treatment, it is still a great challenge for the otorhinolaryngologist. This study was done to perform simple and cost effective test to understand the severity of Allergic Rhinitis. To investigate the patients of allergic rhinitis with specific focus on nasal scrape cytology. After applying inclusion and exclusion criterion were found suitable and hence selected for the present study. 100 patients who were clinically diagnosed on history and examination as allergic rhinitis were included as cases while control group consisted of 100 subjects having no symptoms of allergic rhinitis. These patients were a subjected to nasal scrape cytology for which Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden, was employed. Mucosal specimens were acquired by scraping the surfaces of the middle thirds of inferior turbinates with Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden. The samples thus obtained were transferred onto glass slides to be fixed in 95% ethyl alcohol and stained with May Gurwald Gimesa stain to study pattern and profile of different types of cells like eosinophils, goblet cells, mast cells. The nasal eosinophils were studied under 1000 × magnification of light microscope 10-well spread, high power epithelium fields were examined and the quantitative score of nasal eosinophils was rated according to a scale described by Meltzer. In study group all 100 patients underwent nasal scrape cytology. 25 (25%) patients in study group showed grade 1 + nasal eosinophilia followed by grade ½ + in 24 (24%), grade 0 in 22 (22%) and grade 2 + in 21 (21%). In control group 80% of subjects had grade 0 nasal eosinophilia. Difference between nasal eosinophilia in the study and the control group were found to be statistically significant. In study group 54% showed grading > 0.5 + whereas 46% showed ≤ 0.5 + . The sensitivity and specificity were observed to be 54% and 100% respectively. The results thus found were statistically significant. Nasal scrape cytology which was an added dimension proved to be a more specific than sensitive test. The specificity of nasal scrape cytology in our study was 100%. Sensitivity was only 54%. 22% of the patients of allergic rhinitis showed an eosinophil count more than 300/cu mm.

This study evaluates the outcome of type 1 tympanoplasty with and with out mastoidectomy. The comparative study comprises of 40 patients with CSOM safe type in dry ear. All cases were operated during a period of one and a half years. 20 of these cases were selected for tympanoplasty alone (Group A) and 20 cases were selected for Tympanoplasty with cortical mastoidectomy (Group B). Patients were reviewed after 3 weeks for inspection of the operated ear. The second and third postoperative reviews were done 6 and 12 weeks respectively for clinical assessment of the operated ear with respect to graft status, ear discharge and hearing improvement. The postoperative audiograms were recorded after 3 months. Type I tympanoplasty with cortical mastoidectomy has better graft uptake (100 %) as compared to without mastoidectomy (95 %). Post-operative A–B gap closure is better in tympano-mastoidectomy (20.48 dB) than tympanoplasty (15.75 dB) with p value

To evaluate the incidence of anatomical variations in sinonasal area by nasal endoscopy and CT scan paranasal sinuses and to correlate the anatomical variations in sinonasal area with extent of disease. The present study was conducted on 40 patients of chronic sinusitis. All the patients underwent CT scan paranasal sinus axial and coronal view and nasal endoscopy. The most common anatomical variations were agger nasi cells (80 %), deviated nasal septum (72.5 %) and concha bullosa (47.5 %). Other anatomical variations seen in sinonasal region were uncinate process variations, paradoxical middle turbinate, haller cells, accessory ostia of maxillary sinus, multiseptated sphenoid. Osteomeatal unit (87.5 %) and maxillary sinuses (87.5 %) were the most commonly involved which was followed by anterior ethmoids (70 %), posterior ethmoids (50 %), frontal sinuses (32.5 %) and the sphenoids (20 %). Considering the results obtained, we believe that anatomical variations may increase the risk of sinus mucosal disease. We therefore, emphasize the importance of a careful evaluation of CT study in patients with persistent symptoms of chronic rhinosinusitis.

Cerebellopontine angle lesions are more commonly found in adults; however, they are uncommon in children. 13 year female child presented with progressive cerebellar signs and decreased hearing in left ear. Magnetic resonance imaging was suggestive of left cerebello-pontine angle epidermoid tumor that was treated surgically. In this rare case we discuss the imaging findings and review the relevant literature.

Background There are few published research reports from scattered studies on traumatic brain injuries (TBI) from the developing countries. Objectives We attempted to identify the clinico-social correlates of TBI and to determine the efficiency of documentation to find out the pattern of presentation of TBI at a rural tertiary care teaching hospital. Materials and methods A descriptive observational prospective study was performed from January to June 2010 at a tertiary care rural teaching hospital. Based on WHO guidelines “Standards for Surveillance of Neurotrauma” a data collection tool was designed. After validation by pilot study this data collection questionnaire was subjected to collect information on the participants with diagnosis of traumatic brain injury reported at the Emergency Department (ED). The collected data was entered into the TBI registry database based on Microsoft (MS) excel that was developed for analytical conclusions. Results Out of a total 414 TBI cases, the mean age was 33.47 years, 78.98 percent were male; half of all the victims were in the age 21–40 years; children (6–10 years) (6.76%) and adolescent (11–20 years) (10.39%) comprised a large group; 10.23 percent required resuscitation on admission; the mean duration of hospital stay was 5.42 days. The overall fatality was 7.75 percent; females contributed higher among fatal cases; 10.39 percent were below 10 years and nearly one-fourths (24.40%) less than 20 years is alarming. In the secular trend, highest number (33.57%) of TBI cases was reported in the month of June, followed by March (18.84%). Road traffic injuries were the commonest injury mechanism (56.76%) and mainly in the highways (57.25%). Minor associated injuries were bruises (40.10%) and abrasions (50.97%) and cuts (44.69%). Major associated injuries were few; ear, nose or throat (ENT) Bleeding (2.17%), Limb fracture (5.07%). Alcohol was risk factor in 9.42 percent cases. Of the life threatening computerized tomography (CT) scan findings subarachnoid hemorrhage was noted in 5.59 percent cases. Conclusions Early analysis of a TBI data can lead to useful information but presently there are many lacunae to collect comprehensive information in TBI cases. There is further need to understand the number of variables required and many other requirements for user-friendly secure web-based database system to maintain, analyze and to update continuously for a national TBI registry.

Cerebrospinal fluid (CSF) otorrhoea is an uncommon condition arising from defects in the tegmen and middle cranial fossa. 33 year gentleman presented with post-mastoidectomy CSF otorrhoea of 5 year duration. Imaging finding were suggestive of fracture in the tegmen region. A combined middle cranial fossa/transmastoid was used to repair the defect. Defect was identified in the tegmen plate and it was closed with pedicled pericranial graft, laterally based pedicled temporalis muscle graft reinforced by bone dust and supported with intact mucosal flap. The leak stopped completely following surgery. The patient is doing well at follow up. Repair of these defects need careful analysis of imaging findings to understand pathological anatomy, and a well planned surgical approach to achieve meticulous repair.

The ideal reconstructive material for cranioplasty is autogenous bone, however if it is not available the use of alloplastic materials is recommended. We present a case of 26-year-male patient who sustained compound depressed fracture of the frontal bone and associated anterior cranial fossa fracture following a road traffic accident. He was managed at hospital where the fractured bone fragments were removed but recently presented with watery discharge from nose (CSF rhinorrhoea) and cosmetic deformity of forehead. We describe the utilization of autogenous local frontal bone split calvarial graft for the reconstruction of the defect.

A prospective study was done to access the efficacy of ceruminolytic agents, i.e 2% paradichlorobenzene, 10% sodium bicarbonate, 2.5% acetic acid and normal saline. All score 4 hard impacted ear wax cases in the adult population (>20 years) were accrued for the assessment of the relative efficacy. Upon analyzing the comparative efficacy of four ceruminolytic agents, by taking into consideration three parameters (post) ceruminolytic cerumen score, attempts of syringing required to extrude the cerumen mass, post-ceruminolytic use and appearance of the removed cerumen mass. 2% paradichlorobenzene emerged as the most superior ceruminolytic, closely followed by 10% sodium bicarbonate. 2.5% acetic acid fared moderately while normal saline emerged as the least efficacious ceruminolytic agent.

Schwannomas are well-encapsulated benign neurogenic tumors that arise from the nerve sheaths of peripheral nerves. Schwannomas may occur nearly anywhere in the body, but have a predilection for the head and the neck, with an incidence of 40-50%. Rarely, the cervical nerve root can be the site of a large dumbbell neurogenic tumor in the neck. In the present article, we describe the case of a 40-year-old male with a large schwannoma arising from the cervical nerve root with intrathoracic extension. Surgical excision is the treatment of choice for neurogenic tumors, and it has been described that if the lesion is known to be a schwannoma, it is possible to open the capsule and shell out the tumor from the nerve, possibly avoiding functional deficits. However, as in the present case, it may not be possible to resect the tumor safely from the involved nerve root and it may be necessary to sacrifice the nerve involved in the tumor to achieve complete resection.

INTRODUCTION: Trauma is one of the leading causes of morbidity and mortality in the world and in India. OBJECTIVE: To describe 1) selected epidemiological and clinical characteristics of persons with traumatic brain injury (TBI) who died within 24 h after admission to the emergency departments (EDs) of two medical facilities in rural India and 2) the methods used to transport these patients from the locale of the injury incident to the study sites. MATERIALS AND METHODS: Medical records of all injured patients regardless of age or sex who died within 24 h after admission to both EDs during January 31, 2007 through December 31, 2009 were reviewed and abstracted. Demographic variables and information on prehospital care, time and mechanism of injury, mode of transport to EDs, and primary hospital resuscitation were abstracted and analyzed. RESULTS: Of the 113 injured patients in this study, 42 had TBI and died within 24 h of ED admission. All of these TBI patients were transported to the ED by relatives or bystanders in non-ambulance vehicles. Most of the patients with TBI (78.5%) were 21-50-years-old; and overall 90.0% were males. Persons working near or along busy roads struck by vehicles accounted for 80.9% of all TBI cases. Severe TBIs were present in 97.6% of the patients; of these, 92.8% had a Glasgow Coma Scale (GCS) score of 3 on arrival. Other concurrent injuries included superficial lacerations (85.7%), facial injuries (57.1%), and upper (35.7%) and lower (30.9%) extremity fractures. Common lesions recognized on computed tomography (CT) scan were acute subdural hematoma (21.4%), subarachnoid hemorrhage with diffuse cerebral edema (16.6%), and skull base fracture with diffuse cerebral edema (14.2%); in 21.4% of cases, the CT scan were reported normal. CONCLUSION: Most of the TBI patients who died within 24 h after admission to EDs in this study were not transported to EDs in emergency medical vehicles; most were of working age (ages 20-50 years); were male; and were day laborers working on busy interstate roads where they were hit by vehicles. Language: en

Background: Nasal obstruction is the most common complaint in ENT practice. Surgical correction of deviated nasal septum has been performed by a variety of techniques of which sub mucous resection and Septoplasty procedures of surgical correction of nasal septum play a prime role in management of patients of nasal obstruction. Nasal endoscope is very useful tool to visualize posterior part of septum and do the surgery more precisely and with less complication as compare to conventional method. The objectives of the study were to compare the outcomes of conventional and endoscopic septoplasty, to evaluate the advantages, disadvantages and complications of both endoscopic and conventional septoplastyMethods: 50 cases (between (Oct. 2014 - March 2016) of deviated nasal septum selected in this prospective study and they were randomly divided equally in 2 groups for endoscopic (A) and conventional (B) septoplasty respectively. Results: The study included 50 cases. Majority of patients in this study were males 84% (n=42) and 16% (n=18) were female. 46% (n=23) patients had DNS to right side and 54% (n=27) patients had left side, anterior deviation (48%). C and S shaped deviations (14%). Spur was present in 22% (n=11) of cases and 10% (n=5) patients presented with thickening. After completing 2 months of follow up 92% (n=23) of group A and 88% (n=22) of group B were relieved from nasal discharge, while nasal obstruction was absent in 96% (n=24) patients of group A and 80% (n= 20) of group B. 4% cases (n=1) in endoscopic septoplasty was having persistent deviated nasal septum and 16% (n=4) patients of conventional septoplasty belong to this group.Conclusions: Endoscopic septoplasty has an obvious edge over the conventional approach due to better illumination which enables to identify the pathology accurately, excise the deviated part of septum precisely and realignment of the cartilage for best results.

Background: This study evaluates the outcome of osteopathic manipulation in the patients with globus pharyngeus.Methods: The study comprised of 50 patients with globus pharyngeus. All cases were provided major body diaphragms release namely pelvic diaphragm, abdominal diaphragm, thoracic outlet release, hyoid release, gastroesophageal junction release and sphenoid basilar junction generalized release in some selected cases as per their symptoms. Patients were treated 2 times in a week for 3 weeks. Results: Results were analyzed on the basis of patient’s satisfaction and improvement in the symptoms on regular basis after 2 wks. Visual analogue score (VAS) and clinical assessment were used to see the quantum of satisfaction and overall symptoms. The mean VAS score of patients receiving OMT (MFR) with PPI was 6.23±0.43 and patient who required psychotherapy along with OMT (MFR) had the VAS score of 3.78±0.17 (pConclusions: The patients required multidisciplinary approach hyoid bone release and other osteopathic manipulations, anti-reflux and antipsychotic treatment. The patients having psychological symptoms requiring antipsychotic drugs were found to be least respondent to the treatment. Patients having associated GERD showed a good response to the treatment and their dependency on drugs decreased following the OMT. The best response was seen in patients having no associated ailment and received OMT (MFR).

Background: Chronic rhinosinusitis is an ever increasing problem faced by all sectors of the population throughout the world. Various etiologic factors have been associated with the disease entity but the main concern throughout the world is the increasing antimicrobial resistance which is leading to less compliance and higher treatment cost. Methods: A total of 60 cases and 60 controls were selected and nasal swabs were collected under endoscopic guidance from middle meatus and were sent for culture and sensitivity. Results: The data collected showed that the most common pathogen isolated from the cases was methicillin resistant Staphylococcus aureus (MRSA) accounting for 58.33% followed by fungi and methicillin susceptible Staphylococcus aureus (MSSA). The antibiotic sensitivity showed that MRSA is having the most resistant pattern with only Vancomycin, Teicoplanin and Linezolid having 100% sensitivity followed by Rifampicin, Netilmicin and Clindamycin. Conclusions: From this study we conclude that MRSA is the most common pathogen affecting the cases of chronic sinusitis and it shows a high degree of resistance towards antibiotics which is responsible for incurring higher cost of treatment and low compliance.

Epidermoid cyst is usually due to infection of pilosebaceous gland or due to traumatic migration of epidermis to the deeper structure of skin. They may present in any place of body which is lined by squamous epithelium. They are rarely present in head neck and in oral cavity. We are presenting rare cases of epidermoid cyst presenting in post aural region and floor of mouth.

Solitary neurofi broma is a rare tumor of the head and neck region. It is more common in viscera, where it is associated with features of NF1. It occurs most often between the third and fourth decade. These lesions are extremely rare in infants. We report a case of giant, solitary neurofi broma presenting as a progressive mass in parotid region in an infant. This case is unique in its age of presentation (11 months), site, size (about 8 x 15 cm) without any symptoms or neurological defi cit.

Background: Basic life support (BLS) is all about the prompt recognition of a victim of cardiac arrest or any foreign body obstruction and managing it with cardiopulmonary resuscitation and defibrillation. Objectives: To estimate the extent of awareness about BLS among the undergraduate interns of medical, dental, and physiotherapy College of Maharishi Markandeshwar University, Mullana, Ambala. Materials and Methods: The current study cross-sectional analytical study included the medical interns (MIs), dental interns (DIs), and physiotherapy interns (PIs) of Maharishi Markandeshwar University, Mullana, Ambala. The assessment was done on the basis of a questionnaire containing 20 basic multiple choice questions related to BLS. The students were given 1 h time to attempt the questions and then the assessment was done. The students were graded on the performance based on scores (in percentage) classified as: 90-100 outstanding, 80-89 excellent, 70-79 as very good, 60-69 as good, 50-59 as satisfactory, and

Squamozygomatic mastoiditis is a rare and atypical presentation of acute mastoiditis, presenting as a swelling in front of the ear, with only a few reports in the literature. In contrast to the classic manifestation of acute mastoiditis, atypical form of squamous-zygomatic mastoiditis; the inflammatory process spreads to the zygomatic apophysis and infection reaches the squamous portion of temporal bone and makes a fistula between this portion and the temporal muscle, shifting the pinna of the ear downward. Otorhinolaryngologists must know and remember the possibility of having atypical mastoiditis, and a clinical history, physical examination, mastoid computed tomography scan, and high index of suspicion is important to make a diagnosis of this atypical form of mastoiditis.

Tinnitus is the ringing in the ears heard by the patients in the absence of external sounds. The potential causes for the tinnitus could be the vascular, temporal bone dysfunction, inflammation in the ear, idiopathic, muscular spasms of the middle ear and palatal muscles, functional impairment of the eustachian tube, functional disorders of the jaw, and cervical spine. The author reported a 30-year-old female case who presented with the complaint of buzzing and hissing in the right ear accompanied by the stiffness in the head and neck. Patient had no past medical and surgical history of any ear problem. On otoscopic examination of the tympanic membrane by otolaryngologist no abnormality was detected. In the present case, the diagnosis was made as somatic tinnitus accompanied by reduced cranial sacral motion. The craniosacral osteopathic manipulation was performed which remains the only choice in such cases. In follow-up of 1 month, patient was doing well and is asymptomatic.

Background: Neurosurgical patients including patients with severe head injury are at risk of developing respiratory complications. These can adversely affect the outcome and can result in poor survival. Many studies confirm that tracheostomy is a safe, effective method of airway management for patients with severe head, facial and multisystem organ trauma. Aims: To know the indications for performing early tracheostomy and its outcome. Settings and Design: Retrospective data analysis. Materials and Methods: The present study is a retrospective analysis of all patients who were admitted with the diagnosis of head injury between January 2007 and December 2009 and underwent tracheostomy at a rural tertiary care trauma center of Central India. Results: During the study period, a total of 40 patients with head injury underwent tracheostomy. All the patients sustained head injury in road traffic accidents. The mean age of the patients was 37.6 years (range 14–75 years, standard deviation 14 ± 14.9 years). Maximum number of patients were in their third decade of life, followed by those in the fifth and fourth decades. There were 36 males and 4 females. Tracheostomy was performed in 30 patients with severe head injury, 9 patients with moderate head injury and in only one case of mild head injury as the patient had multiple facial injuries compromising the airway. Conclusions: Neurocritical care is a relatively new field in India, and the facilities for critical neurosurgical patients are available only in a very few tertiary care centers mainly serving the urban areas. In the present study, we discuss our limited experience with tracheostomy in patients with head injury while facing the challenge of limited resources.

Odontogenic keratocyst are known for there recurrence and local bone destruction. They have bimodal age presentation. OKC is common in lower jaw than upper jaw. They are usually asymptomatic and diagnosed during radiological investigation. We are reporting this case because of its age presentation (70 years), site of presentation (maxillary canine region) and mode of presentation (chronic palatal pus discharging sinus).

Nasopharyngeal cysts are rare, small in size and asymptomatic, usually diagnosed as in incidental finding on MRI. Large cyst commonly presents with obstructive symptoms. Tornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. They represent as a communication between notochord remnants and the pharyngeal endoderm. We report this case because of its presentation and size (2.5 × 2 cm). It was presented as intermittent cervical pain, stiffness and vertigo because of prevertebral cervical muscle spasm due to cyst and nasal symptoms were not predominant. Although rare, it should be kept as a differential diagnosis for cervical myelgia and stiffness.

65 year old male presented to us with swelling on right side of neck which was progressively increasing since last 1 year. Moving with deglutition but not with the protrusion of tongue, FNAC and ultrasonography of the swelling suggested possibility of thyroglossal cyst (TGD). Histopathological report, on removal, by Sistrunk operation confirmed the same. Presence of TGD at the ripe age of 65 years, huge size, multilobular nature and absence of classical signs of TGD, in our patient prompted us to report this case.

Background and ObjectivesAnalyses of causes and trends of traumatic brain injuries help to define public health policy priorities. There are not much TBI registries, thus making documentation of injuries inadequate and accessing these data problematic. This study is aimed at identifying the characteristics of TBI and determining the efficiency of documentation of patients' records in a tertiary hospital.Patients and MethodsBased on WHO guidelines “Standards for Surveillance of Neurotrauma” we designed a proforma to collect data on traumatic brain injuries. A prospective data collection was done from January to June 2010. Data was collected on a paper form and then entered into the self-developed TBI registry database. Descriptive analysis was performed.ResultsData for a total 414 patients were collected. Mean age was 33.00 years (SD ± 16.725, range 1–85 years), and 81% male. Most of the accidents took place on highways (57.2%), commonest being the road traffic accidents (55.1%), brought by relatives (74%). The mean duration for hospital stay was 5.42 days (SD ± 8.312 days, range 1-79 days). 10% patients required resuscitation at the time of admission. Details of Glasgow coma scale were available; details regarding CT scan findings were available for 300 patients. Good recovery was seen in 68.4% and the mortality was in 7.2%. Further details on vital parameters and investigations included in the study were also collected.ConclusionsTBI related research in many developing countries is in the developmental stages with relatively few published data. Although early analysis of a TBI data can lead to useful information, there is further need for the development of a user-friendly secure web-based database system to continuously maintain and analyze the registry.

Aims and Objective: The present study was undertaken to compare the results of various autogeneous tissues temporalis fascia, tragal perichondrium, and fascia lata as graft materials for the type 1 tympanoplasty. Materials and Methods: A total of 120 cases with large, subtotal and total perforation were considered in the study. Of the 120 cases, temporalis fascia graft was used in 60 cases (Group-I), tragal perichondrium graft in 40 cases (Group-II), and fascia lata graft in 20 cases (Group-III). The results were evaluated in the form of rate of graft success, hearing gain, and mean residual air-bone gap with respect to the graft materials. Results and Observation: A nonsignificant association was observed between the groups, that is, temporalis fascia (Group-I), tragal perichondrium (Group-II), and fascia lata (Group-III) and the graft uptake. ( P = 0.96 > 0.05) and air bone closure ( χ 2 = 2.908, P = 0.059 > 0.05). Conclusion: The graft take-up rate and Hearing improvement are similar for the different graft materials used. Size of the perforation doesn't significantly influence the success rate of tympanoplasty as per our study. Normal translucent appearance of neotympanum in the postoperative period was seen only with temporalis fascia, while in tragal perichondrial and fascia lata grafts the neotympanum was whitish, thicker, and translucent to opaque.

Cranio-cerebral invasive aspergillosis of sino-nasal involving the skull base is rare and associated with a very high mortality due to its peculiarly fulminant clinical course. We present an unusual case of 55-year-old diabetic female who initially treated for phytophotodermatitis, but later on she developed massive invasive cerebral aspergillosis. Advances in diagnosis and management of aspergillosis with improved and early detection and more effective therapy have promised some success in the management of these devastating infections.

ObjectiveTrauma is one of the leading causes of morbidity and mortality across the world with traumatic brain injury (TBI) being an important cause of trauma related deaths. The aim of our study was to review the medical charts of patients who died within 24 hours of presentation to our Hospital after head injury.MethodsWe received approval from the institutional review board to conduct a retrospective review of patient charts at Acharaya Vinoba Bhave Rural Hospital, in Sawangi (M), Maharashtra (India). All patients who died within 24 hours of the presentation to the emergency department (ED) and had been diagnosed with TBI were included in the study. We collected data from 113 charts between January 2007 and December 2009.ResultsDuring this three year period, 113 patients died within 24 Hours of admission to the hospital. Of these, 37% (42/113) were diagnosed with (TBI). We conducted a chart review of these 42 patients. All our patients were brought to the ED by relatives or bystanders in non-ambulance vehicles. At the time of presentation to the ED, nearly all patients were normotensive, with only one patient with hypotension The Majority of our patients had a Glasgow Coma Scale of less than 5.ConclusionOur study brings to light various deficiencies in rural India, trauma care which include immediate rescue and transportation. Although patients were provided the optimum care in the ED, however it was not associated with favorable outcome. This highlights the need of a Trauma Registry to record real-time data which will help to improve care and systems.

Metastatic carcinomas from a distant primary malignancy involving the temporal bone particularly the jugular foramen are rare tumors. A 57-year-old gentleman had multiple gradually increasing swellings over the body since many years. For last two years, he noticed enlargement of the swelling in left calf and rapidly enlarging painful new swelling over the left chest wall in back for last one year. He had recent involvement of left seventh, eighth and lower cranial nerves. CT scan showed an extensive lesion in left jugular foramen region with bone destruction. The patient underwent decompression of the left jugular foramen mass lesion. The tumor was extremely vascular and a partial decompression could only be performed. Although there was relief in the headache but the neurological deficits were persisting. Histopathology of the tumor showed features of metastatic small ling cancer. In the present case, there was presence of long standing multiple swelling all over the body and the patient had painful enlargement that he perceived as an ongoing process of the von Recklinghausen′s disease and made a delay in seeking the medical advice resulting in a well advanced disease and with poor prognosis.

Blunt trauma to the parotid gland is extremely rare and requires considerable force. We present a unique case in which a child sustained parotid injury without any associated injury to the facial skeleton, parotid gland and ductal structures and managed successfully. A literature search revealed that this type of injury has not been reported previously.