Farhat Qamruddin Khan

Tympanic Membrane Perforations (TMP), resulting from trauma or infections, can result in auditory impairment and recurring infections. Conventional surgical techniques, such as tympanoplasty, employ autologous grafts such fascia and cartilage; however, these approaches can be invasive, result in scarring and are subject to limitations including graft rejection and increased costs. Biomaterials such as Hyaluronic Acid (HA), collagen and gelatin sponges are being explored for Tympanic Membrane (TM) repair to resolve these issues. HA, recognised for its function in tissue regeneration, has demonstrated efficacy in facilitating TM healing by cell proliferation and revascularisation. Techniques such as HA fat graft myringoplasty have attained success rates of up to 92.7%. Collagen, another crucial biomaterial, promotes fibroblast proliferation and aids in the restoration of the TM’s fibrous layer. Repairs utilising collagen have exhibited success rates between 66.7% and 92%, contingent upon the extent of the perforation. Gelatin sponges, commonly utilised as scaffolds in the healing process, offer structural support and mitigate inflammation. These biomaterials have substantial advantages, including diminished surgical complications, expedited healing period and minimised scarring, rendering them advantageous substitutes for conventional grafts. Biomaterials are particularly advantageous in situations where autologous tissue grafting is impractical, offering effective and novel techniques for TM restoration. The review discusses advancements in the treatment of TMPs employing biomaterials.

Background: Usually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis. Results: This is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death. Conclusion: Effective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease.

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Rhinocerebral mucormycosis is an uncommon, rapidly advancing, catastrophic, opportunistic fungal infection that predominantly affects metabolic and/or immunologically challenged individuals. Its frequency has increased dramatically since the SARS-COV-19 epidemic. The disease has been described as having distinct clinical categories, namely: rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated. Extranasal dissemination has been invariably linked with an increased risk of death.Though an aggressive disease with a substantial rate of mortality, seeking timely help, prompt investigations and diagnosis, treatment with higher antibiotics, oral or intravenous antifungals, rigorous surgical excision, and control of underlying comorbidities has resulted in effective disease management and control with a gratifying outcome and lower morbidity when compared to the pre COVID era.We present a case of sinonasal mucormycosis with ocular, oral, pulmonary, and intracranial involvement in a young post COVID-19 immunocompromised male patient who was optimally treated with a comprehensive endoscopic surgical approach and combined with oral and systemic liposomal amphotericin B therapy.

Inverted papilloma or Ringertz tumour is an uncommon benign tumour that arises from the Schneiderian membrane of the ectoderm. It accounts for approximately 70% of all sinonasal papillomas and 0.5-4.0% of all sinonasal tract neoplasms. It often originates in the middle meatus of the lateral nasal wall and is well-known for its local invasiveness and high recurrence rate. Nasal obstruction, nasal bleeding, and diminished sense of smell are the most common symptoms. Hereby, authors report a case of 58-year-old male complaining of right nasal obstruction since 3 months. Patient had nasal growth for which he underwent nasal endoscopy. History revealed that he had similar growth on left side 10 years ago. A nasal endoscopic biopsy was performed and the histopathological examination show an inverted growth pattern from the sinonasal papilloma. Surgical techniques must be extensively explored and customised, with enhanced radiological assessment of tumour borders, in order to adequately remove the tumour, since incomplete excision increases the risk of recurrence and malignant transformation of the residual disease.

Chronic otitis media is generally more prevalent in individuals with a weakly pneumatized temporal bone, whereas acute otitis media has a propensity for pneumatized temporal bone. Antimicrobial drugs are thought to have influenced the incidence and progression of middle ear infections. The mastoid air cell system, a part of the middle ear cleft, has recently been recognized as a crucial factor in the genesis, behaviour, course, and outcome of middle ear inflammatory conditions. Epithelium infiltrates the growing bone and produces epithelium-lined air cell chambers, a process known as pneumatization. Conventional temporal bone radiography, i.e. X-ray mastoid, has not kept up with recent otology breakthroughs. Detailed visualization of the aural structures has advanced significantly with the introduction of high-resolution computed tomography (HRCT). HRCT has a clear edge in the assessment of the temporal bone, especially when thin-section, high-resolution methods are used, resulting in a more precise description of the pneumatization pattern and the anatomical extent of middle ear pathology. Our results of the review indicated that persistent inflammation of the middle ear in children inhibits pneumatization of the temporal bone. Due to its potential to exert a greater negative middle ear pressure, the middle ear volume is insufficient to generate a retraction pocket; thus, the size and state of the antrum is also a significant factor in the establishment of a COM-like retraction pocket in inactive squamosal disease. Numerous factors, including the number of patients, regional, genetic, ethnic and hereditary characteristics, as well as the cellularity of the mastoid, which is impacted by a multitude of factors, may account for the variable reports and inter-study variation in this regard.

Dentigerous cysts are benign, slow-growing odontogenic cysts that are considered to be developmental in origin. They are twice as common in men than in women, and most often occur in people between the ages of 20 and 40 years. They are rarely found in young children. They almost exclusively occur in permanent dentition and over 70% of total number of cases are located in the mandible. Dentigerous cysts most commonly involve the mandibular third molar and are infrequent in maxillary canines. They can grow to a considerable size causing painless expansion of the jaw leading to its deformity. We report a rare and challenging case of ectopically erupted massive dentigerous cyst of maxillary canine in the anterolateral wall of left maxilla leading to facial deformity and shed a light on its surgical management by the endonasal endoscopic approach in a female pediatric patient.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis, an acid-fast bacillus that is predominantly transmitted through the respiratory system. Although TB most commonly infects the lungs, it may also affect other organs, resulting in secondary extrapulmonary TB. Extrapulmonary TB may occur alone or in conjunction with a primary pulmonary focus, such as disseminated TB resulting from self-inoculation with infected sputum, blood, or lymphatics. The lymph nodes are the most commonly seen extrapulmonary sites of TB. Oropharyngeal tubercular lesions are infrequent, and primary TB of the oropharynx is even more uncommon. Here, we present an unusual case of oropharyngeal TB in a young immunocompetent patient occurring without any evidence of pulmonary TB or cervical lymphadenopathy.