More than a century ago, Ortner described a case of cardiovocal syndrome wherein he attributed a case of left vocal fold immobility to compression of the recurrent laryngeal nerve by a dilated left atrium in a patient with mitral valve stenosis. Since then, the term Ortner's syndrome has come to encompass any nonmalignant, cardiac, intrathoracic process that results in embarrassment of either recurrent laryngeal nerve-usually by stretching, pulling, or compression; and causes vocal fold paralysis. Not surprisingly, the left recurrent laryngeal nerve, with its longer course around the aortic arch, is more frequently involved than the right nerve, which passes around the subclavian artery.Objectives: To discuss the pathogenesis of hoarseness resulting from cardiovascular disorders involving the recurrent laryngeal nerve along with the findings of literature review. Materials and methods:This paper reports a series of four cases of Ortner's syndrome occurring due to different causes.Design: Case study. Result:Ortner's syndrome could be a cause of hoarseness of voice in patients with cardiovascular diseases. Conclusion:Although hoarseness of voice is frequently encountered in the Otolaryngology outpatient department, cardiovascular-related hoarseness is an unusual presentation. Indirect laryngoscopy should be routinely performed in all cases of heart disease. Braz J Otorhinolaryngol. 2011;77(5):559-62. ORIGINAL ARTICLE

Chronic tonsillitis and tonsillar hypertrophy cause alterations in some acoustic measurements, which make the voice dysharmonic and harsh. Tonsillectomy eliminates nasalance and lowers shimmer. Overall, it does not significantly alter dysphonia owing to disease.

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Tracheostomy is a commonly performed airway surgery for critically ill patients. Tracheostomy tube is an indwelling prosthesis, providing potential surface for growth of bacteria. Biofilm formation by bacteria as a self-protective mechanism, has led to worrisome antibacterial resistance and thus higher rate of nosocomial infections. A prospective observational study was conducted with a purpose of knowing most common organisms capable of forming biofilm on tracheostomy tube and their antibiotic sensitivity in our setting. Fifty seven percent of the isolates were found to be capable of biofilm production. Acinetobacter baumannii (45%) was the commonest biofilm producer isolated and the commonest multidrug resistant organism (35.7%), followed by Klebsiella pneumoniae (28.5%) . Both biofilm producers and non-biofilm producers were found most susceptible to Amikacin (43%), followed by Gentamicin (30%) and Ciprofloxacin (18.5%). No significant association was found between biofilms and ventilators (p value = 0.558) or pre-existing infection (p value = 0.66) using Chi square test. Potentially biofilm producing bacteria were isolated from tracheostomy tube inner surfaces just after a week of their insertion, in majority of patients. Acinetobacter baumannii and Klebsiella pneumoniae were the commonest biofilm forming organisms and Amikacin, Gentamicin and Ciprofloxacin were most sensitive drugs. Multi drug resistant organisms were also commonly found, stressing the need for sensitivity-based antibiotics. Ventilator usage had no strong association with biofilm formation. Patients with non-infectious conditions also harboured bacteria capable of biofilms in tracheostomy tubes demanding the need for stringent tube hygiene measures and prophylactic antibiotics.

The most common type of malignancy affecting the upper aerodigestive tract is squamous cell carcinoma. Basaloid squamous cell carcinoma (BSCC) is a rarely seen, high-grade, bimorphic variant of squamous cell carcinoma, which displays distinct histological features. This entity was first described by Wain et al. in 1986. Since then, approximately 170 cases of head and neck basaloid squamous cell carcinoma have been reported. Tonsils are an uncommon site of occurrence of basaloid cell carcinoma. Only 10 cases of basaloid squamous cell carcinoma arising in the tonsils have been described in current English literature. Histopathologically, these carcinomas are characterised by the presence of a basaloid component in close association with squamous cell carcinoma. In this article, a case of BSCC of the tonsil is reported. The clinical and histopathological features of this tumour are discussed. Relevant literature has been reviewed and differential diagnosis of this tumour is discussed.

Endoscopic endonasal approaches are becoming increasingly popular over transcranial approaches for repair of cerebrospinal leak defects. Sphenoid sinus CSF leaks pose a significant challenge and carry the risk of life-threatening intracranial complications. Their management depends upon identifying the leak using imaging techniques followed by intraoperative endoscopic localization. Our experience in the endoscopic endonasal management of sphenoid sinus CSF leaks is reported in this paper.

The extracranial occurrence of meningioma, which is a tumour of the central nervous system, is rare. Two cases of primary extracranial meningioma of the psammomatous variant are reported here. Both cases were managed successfully by endoscopic endonasal approach. Literature has been reviewed and their clinicopathological features are described.

<p class="abstract"><strong>Background:</strong> Cleft lip and cleft palate are the commonest congenital anomalies of the orofacial region. The<strong> </strong>incidence of middle ear problems and hearing loss is reported to be higher in children with cleft palate &amp;/or cleft lip.</p><p class="abstract"><strong>Methods:</strong> A prospective, observational case-control study comprising 80 subjects (40 cases and 40 controls) was undertaken at Yenepoya Medical College Hospital, Mangalore, Karnataka, India. All subjects enrolled were subjected to detailed ENT examination including otoscopy, pure tone audiometry and impedance audiometry.  </p><p class="abstract"><strong>Results:</strong> Retracted tympanic membrane suggestive of Otitis Media with Effusion (OME) and conductive hearing loss was observed in more than 50% of patients with cleft palate &amp;/or cleft lip. Tympanogram of B type suggesting OME was observed in 27% of cases. Chronic otitis media was observed in 32.5% of cases.</p><strong>Conclusions:</strong> The prevalence of OME, Chronic otitis media and hearing loss was observed to be higher among children with cleft palate &amp;/or cleft lip. Otological and audiometric assessment should be performed for all patients having cleft palate &amp;/or cleft lip atleast before surgery in order to facilitate early identification and intervention for middle ear problems particularly middle ear effusion.