Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings.Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors.Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed.Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%.Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.

Introduction: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5–10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. Material and methods: A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). Results: A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin’s tumour on histopathology) and none were true negative. Conclusion: FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.

Objectives: As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia.Methods: A systematic review and meta‐analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials andClinicalTrials.gov. There were no limitations on year of publication or language.Results: Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta‐analysis showed surgical time was significantly shorter under LA.Conclusions: CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost‐effectiveness profile. However, larger scale, robust trials are required to assess this further.

Introduction Thyroglossal duct cyst (TGDC) is the most common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type of malignancy, the most common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.

Objectives: Tracheomalacia is defined as the weakening of the tracheal rings secondary to long‐standing compression or inherent structural weakness, leading to stridor and airway compromise. The common etiological factor of tracheomalacia includes compression of the tracheal framework due to a large multinodular goiter. There are various management techniques described in the literature to manage a patient with tracheomalacia including tracheostomy, tracheal stenting, and tracheopexy. However, the evidence of tracheomalacia in the literature is conflicting. Therefore, a systematic review was conducted to estimate the incidence of tracheomalacia after thyroidectomy.Methods: The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A literature search was performed on PubMed, Web of Science, Cochrane library, and Elton B. Stephens Co. cumulative index to nursing and allied health literature plus to determine the incidence of tracheomalacia among patients undergoing thyroidectomy up till October 2021. The eligibility was assessed by two independent authors. A quality assessment of individual studies was performed using the National Institute of Health quality assessment tool. Outcomes were double data extracted and were analyzed using OpenMeta.Results: The online search retrieved 214 papers, out of which 17 studies were included that fulfilled the eligibility criteria. The number of patients included in the systematic review who underwent thyroidectomy was 1108. The mean age was 55.8 ± 7.7 years, ranging from 48 to 75 years. Tracheomalacia was reported in 146 patients (1.4%). Sternotomy was performed in 102 patients to approach the goiters with retrosternal extension. The most common intervention to manage tracheomalacia was tracheostomy or prolonged intubation.Conclusions: Tracheomalacia is a rare complication. In cases where tracheomalacia is encountered, common methods of management include tracheostomy or prolonged endotracheal intubation. Prospective, long‐term studies are required to accurately assess its true incidence and associated factors.