Current status of cell-free DNA in head and neck cancer management Ashish Singhal, Akhlak Hussain, Akash Agarwal, Bimlesh Thakur Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):1-7 Tissue biopsies are temporally and spatially limited and often provide a brief snapshot of a single region of a heterogeneous tumor. Carcinogenesis is a complex process in which heterogeneity plays an important role in the development and progression. Research efforts are going on focusing on the discovery of new, noninvasive methods for the diagnosis, and comprehension of the tumor genomic architecture to monitor tumor evolution and therapeutic response in real time. Liquid biopsy is a noninvasive diagnostic tool that can provide a personalized snapshot of primary and metastatic tumor at successive time points, providing knowledge of the tumor burden so as to detect early evidence of recurrence or resistance to the disease and helping clinicians in their therapeutic decision-making. Therefore, using liquid biopsies, we can obtain a molecular profile for each patient. We intended to review cell-free DNA (cfDNA) in oral cancer. We described cfDNA considering their levels, diagnostic value, prognostic value, predictive value.

Atresioplasty for congenital aural atresia: A not so gloomy outlook Naresh K Panda, Niveditha Damodaran, Gyanranjan Nayak, Roshan Kumar Verma Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):8-12 Introduction: Congenital aural atresia (CAA) is an abnormality of the external ear along with hypoplasia or aplasia of the external auditory canal. Surgery of aural atresia is not only challenging but also has not been accepted by the surgeons. Many surgeons hesitate to undertake the repair due to inadequate hearing outcome and probability of stenosis of the new canal. This report presents the authors' experience of surgical treatment of aural atresia. Materials and Methods: A retrospective analysis of 31 cases of CAA operated during 2002–2018 in a tertiary referral center was performed. Unilateral atresia was more common. A combined anterior and posterior approach was employed in all the cases. Postoperatively, the patients were evaluated for hearing improvement and any sequelae of surgery at varying period up to 3 months. Results: Twenty-eight patients underwent surgery after exclusion of three patients due to diploic mastoids. A postoperative air-bone closure of >25 dB was achieved in 15 out of 28 patients. Five patients had air-bone closure of 15–25 dB. Only 8 patients did not have any hearing improvement. Meatal stenosis occurred in 2 patients. There were no other complications. Conclusions: Patients with CAA of moderate grade favorable radiological findings may benefit with surgery for better hearing outcomes. Bone-anchored hearing devices can be advised if the surgery is not feasible, particularly in high-grade atresia and unfavorable radiology.

Human cerumen and its antimicrobial properties: Study at a tertiary care teaching hospital of Eastern India Santosh Kumar Swain, Nishtha Anand, Mahesh Chandra Sahu Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):13-16 Aim: This study aimed to find out the antibacterial and antifungal properties of the human cerumen. Materials and Methods: This is a prospective study conducted at the department of otorhinolaryngology and medical research laboratory of a tertiary care teaching hospital of Eastern India between December 2016 and November 2018 for assessing the antibacterial and antifungal properties of the human cerumen. Cerumen was collected from 102 healthy persons by using sterile Jobson Horne Probe. Sterile samples were taken for the study. Results: Out of the 102 samples, 68 sterile samples were considered for the study. At a dilution of 1 in 105, there was complete inhibition of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa in all the samples. In this study, cerumen inhibited the bacteria in the order of E. coli > S. aureus > P. aeruginosa > Haemophilus influenzae > Aspergillus niger > Candida albicans. Conclusion: Cerumen or earwax of the human being has antibacterial and antifungal properties. Other than antibacterial and antifungal properties, it also protects the eardrum by acting as a physical barrier. Hence, cerumen cleaning is not advisable unless it is causing symptoms such as otalgia or hearing loss.

Cone beam computed tomography versus digital orthopantomography in sinus augmentation procedures: 2D versus 3D imaging G Santosh Reddy, Amit S Nimkar, Pratyaksha S Panwar, Anitha Bhupathi, J Priyanka, S Aswini Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):17-25 Context and Aim: Radiology as well as higher imaging modalities has their own advantages and disadvantages. The present study was designed to do a comparative analysis of the role of cone-beam computed tomography (CBCT) and orthopantomography (OPG) for preoperative planning and postoperative evaluation of treatment outcomes in implant therapy in combination with sinus augmentation procedures. Materials and Methods: Pre- and post-operative assessment of maxillary sinuses was done in 17 patients who underwent implant therapy in combination with sinus augmentation procedures using CBCT and OPG. Statistical Analysis: Statistical analysis was done using IBM SPSS statistics 20 (Chicago, USA). Paired and Unpaired t-tests were used to do a comparative analysis of the two modalities used. Results: There was a concordance between the treatment type based on pre- and post-operative CBCT assessments. The assessment of sinus morphology revealed a significantly higher detection rate of aberrations in the form of sinus mucosal hypertrophy and septae on CBCT which were imperceptible on orthopantomographs undermining the role of routine radiography in these procedures. The results obtained, also, revealed that vertical alveolar bone height could be measured more precisely with CBCT. Conclusion: Based on the findings of the above study, it could be concluded that CBCT increased the accuracy of both, the sinus morphology assessment as well as the estimation of gain in vertical alveolar bone height, in addition to bone density, which remains un-assessed by the conventional radiological techniques including OPG.

Questionnaire on the “Knowledge and use of ear molds” by the hearing aid users N Devi, MT Jayaram, R Udhayakumar Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):26-30 Background Information: Ear molds are a part of hearing instrument made up of silicon which connects the hearing aid to the user's ear canal. These ear molds act as reservoir to collect the sound from the hearing aid. However, the knowledge about this is very less among the users. Professionals forget that the satisfactory usage of the hearing aid also depends on the ear mould which is always recommended for those individual who are fitted with the hearing aid. Aim and Objectives: The aim of the current study is to develop and standardize a questionnaire on the 'Knowledge and use of ear moulds' by the hearing aid users. Also, to compare the scores of the questionnaire between two groups who are divided with respect to different period of usage of ear molds. Materials and Methods: A total of sixty participants, were divided into two groups, as those individuals who used the ear moulds with hearing aid only for a period of 6 months and more than 6 months. The developed questionnaire consists of 20 questions with four choices for response. Along with the developed questionnaire a 'Hearing Aid Users Questionnaire' (HAUQ) was also administered for correlation regarding satisfaction. Results and Conclusions: Independent t-test results reveled that there was significant difference in the scores between the groups of participants. There was positive correlation between the administered questionnaires. Satisfaction is crucial to the whole hearing aid fitting process including ear mould fitting and its importance in audiology is evidenced by the fact that it is frequently included as a measure of outcome. This concludes that satisfaction is crucial to the whole hearing aid fitting process including ear mould fitting, knowledge on ear mould usage and care.

Prevalence of pathologic findings in maxillary sinuses in asymptomatic patients using cone-beam computed tomography S Manoj Kumar, G Santosh Reddy, B Ramesh Naidu, Amit S Nimkar, M Deivanayagi, KV Chalapathi, Abhishek S Nayyar Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):31-37 Context and Aim: Complications related to maxillary sinuses are often related to their anatomic and pathologic variations and their close approximation to the tooth roots. It, thus, becomes important to study these sinuses even in situations when the patients reporting for dental complaints are asymptomatic for the sinuses. In the present scenario, cone-beam computed tomography (CBCT) has emerged as the standard imaging modality for bone and soft-tissue abnormalities offering multiple views with thin sectioning. The aim of the present study was to detect the prevalence of pathologic findings in maxillary sinuses in patients who were asymptomatic for the sinuses using CBCT. Materials and Methods: CBCT scans of 150 patients between the ages of 18 and 70 years reporting for routine dental complaints were analyzed for detecting pathologic findings in the maxillary sinuses. Statistical Analysis Used: The data were analyzed using the SPSS software version 15.0 (SPSS Inc., Chicago, IL, USA). Distribution of the overall prevalence of pathologic findings according to age and sex were calculated using the Chi-Square test whileP < 0.05 was considered to be statistically significant. Results: Overall prevalence of pathologic findings was found to be 58%, with the prevalence of mucosal thickening (MT) being 29.3%, polypoidal MT, 36.7%, partial opacification with liquid accumulation, 2%, complete opacification, 0.7%, and miscellaneous findings as 0.7%. Conclusion: The present study highlighted the clinical implications, dental pathologies might have, in relation to the maxillary sinuses underlying the significance of their accurate assessment in the perspective of dental and maxillofacial and ENT problems with a multidisciplinary approach of treatment for the successful treatment of chronic sinus pathoses.

Glomangiopericytoma: A rare sinonasal tumor in a young female Sankha Subhra Sinha, Dipanwita Nag, Nandini Das, Aparajita Samaddar Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):38-41 Glomangiopericytoma (GPC)/sinonasal type hemangiopericytoma (HPC) is a rare sinonasal neoplasm arising from the pericytes surrounding capillaries and accounts for <0.5% of all sinonasal tumors. This tumor differs from conventional soft-tissue HPC in location, biologic behavior, and histologic features. GPC is a borderline tumor of low malignant potential with a good prognosis after complete surgical resection. We report a case of a 20-year-old woman who presented with progressive nasal obstruction and frequent nasal bleeding and was diagnosed as GPC on histopathological and immunohistochemistry findings. Histological characteristics, differential diagnosis, and prognosis of this tumor are discussed in this article. This case has been reported because of its rarity and an array of differential diagnosis.

Idiopathic primary supraglottic laryngeal abscess Shubhankar Gupta, Saurabh Varshney, Manu Malhotra, Amit Kumar Tyagi, Amit Kumar Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):42-44 Laryngeal abscess is a suppurative submucosal connective tissue inflammation of the larynx. It is rare but can be life-threatening due to its potential for airway obstruction. The etiology and thus treatment has changed drastically from pre- to postantibiotic era. We are hereby reporting an interesting rare case of laryngeal abscess in this postantibiotic era. Current etiological factors and modes of presentation are also discussed in this article.

Otologic presentation of multiple myeloma with isolated temporal bone involvement: Diagnostic and therapeutic implications JG Aishwarya, Satish Nair, Parameswaran Anoop, Swarna Shivakumar, Aruna R Patil, Satish Babu Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):45-48 Plasma cell disorder spectrum ranges from the benign plasma cell granuloma to malignant multiple myeloma characterized by the monoclonal proliferation of plasma cells. Multiple myeloma with temporal bone involvement is a rare entity and may present with nonspecific otological symptoms similar to chronic ear disease leading to a diagnostic challenge. Suspicion of multiple myeloma involving temporal bone primarily is difficult, and most of the cases are diagnosed after initial surgical excision. The differential diagnosis includes temporal bone carcinoma and glomus tumor due to similar radiological features. The final diagnosis is, however, made by the histopathological and immunohistochemical analysis. The mainstay of treatment of multiple myeloma is chemotherapy; however, surgical excision of the lesion is warranted in cases of pressure symptoms and intracranial involvement. We present a case who presented with ear canal mass, facial palsy, and cerebellar symptoms and was diagnosed to be a case of multiple myeloma with temporal bone involvement and was treated successfully. He is on regular follow-up for 1 year and remains in complete remission.

Utility of acitretin in improving quality of life in lipoid proteinosis Tejas Vishwanath, Rachita Dhurat, Sneha Borawake, Anagha Joshi, Sandip Agrawal, Smita Ghate Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2019 3(1):49-53 Lipoid proteinosis is a rare autosomal recessive disorder, the exact incidence of which is unknown. It initially manifests as hoarseness followed by cutaneous findings, including blisters on trauma-prone sites, waxy papules, and pock-like atrophic scarring. Major morbidity in this disease is persistent hoarseness due to hyaline deposition on the vocal cords. Acitretin has recently been discovered to have a prominent role in the improvement of cutaneous manifestations and hoarseness of voice caused by this disease. We report one such case with documented improvement in voice with voice samples and direct laryngoscopic findings before and after treatment with acitretin.