IgG4-related disease (IgG4-RD) which is a protein disorder presented as a mass in the right carotid triangle in a 30 year male patient, who underwent battery of tests is described. The radiologist opined the mass as paraganglioma and the spindle shaped character of the mass also suggested neurogenic tumor in differential diagnosis. Reference to vascular surgeon also opined the same, and adviced for incisional biopsy. Histopathology report suggested IgG4-RD and immunochemistry confirmed the final diagnosis. The neck mass which we opined as a single organ disease, proved to be multiorgan disease in PET scan.

To evaluate the role of video head impulse test in the diagnosis of peripheral vestibular disorders, we performed an observational study in the outpatient department in a tertiary setup in which the clinical head impulse test and the video head impulse test were performed on 45 patients with clinically suspected peripheral vestibular disorders, and their results were correlated. To analyse our results, each ear was counted individually and hence, among 45 patients, 12 out of 90 ears showed abnormal clinical head impulse test for lateral semicircular canals and 27 out of 90 ears showed abnormal video head impulse test for lateral semicircular canals. This gave us an additional diagnostic accuracy of 21.1% on using video head impulse test for the lateral semicircular canals as compared to the clinical head impulse test. Video head impulse test is a physiological, quick and well tolerated test for assessing the vestibular function, and the only practical test for assessing the vertical semicircular canal function. Video head impulse test provides valuable information in localising the site of lesion as it assesses the semicircular canals individually. Video head impulse is merely not an objectification and registration system for the clinical head impulse test as it provides additional information such as vestibulo-ocular reflex gain, and occurrence of covert refixation saccades which cannot be picked up by naked eyes.

<p>Schwannomas are less common benign slow growing tumors originating from Schwann cells. In the head and neck region, schwannomas arise most commonly from the vagus nerve or the sympathetic chain. We present this case as the location of schwannoma is extremely rare and due to the diagnostic difficulties it posed. A 48 year old male presented with right neck swelling and breathing difficulty to our OPD. Patient underwent ultrasonogram of neck, MRI neck and Fine needle aspiration cytology (FNAC) of the lesion. Each of the investigations suggested different pathology which made the diagnosis challenging. During surgery, the lesion was found to arise from right recurrent laryngeal nerve. After excision of the lesion, the patient developed hoarse voice and the pathological examination revealed schwannoma. Schwannomas that originate from Schwann cells can affect any part of the body. MRI, CT, USG and FNAC have been suggested in the literature for diagnosing the lesion. Trucut biopsy should be considered in situations where FNAC becomes inconclusive. Surgical excision is the treatment of choice. Histologically, five variants of schwannomas have been described in the literature namely common, plexiform, cellular, epithelioid and ancient schwannoma. To conclude, schwannoma arising from RLN which masqueraded as a thyroid swelling is a rare entity. The diagnostic modalities suggested in the literature were unable to pin point the diagnosis. Once, FNAC shows an inadequate specimen, a trucut biopsy should be considered as the next investigation modality.</p>

Objective: 1. To highlight the rare presentation of a metallic grommet in the Eustachian tube.2. To highlight how the metallic grommet entered the Eustachian tube.3. To suggest how the foreign body can be removed from the Eustachian tube if symptomatic.Case report: A 49 year old lady presented with symptoms of tinnitus and intolerance to loud sounds in right ear after tympanoplasty. HRCT showed a metallic grommet in the left Eustachian tube. We conjectured that the metallic grommet accidentally slipped into middle ear and could not be retrieved by the treating surgeon. The foreign body migrated to the Eustachian tube. Conclusion:Metallic foreign body in the Eustachian tube is a rare presentation and it posed a diagnostic dilemma how it entered the Eustachian tube. We discussed the possibilities and the method to retrieve when the symptoms appear. A simple or a complicated surgical procedure (Skull Base) may be undertaken if symptomatic.

<p class="abstract">Neck node in sub mental area is not uncommon. It occurs mostly due to infective or malignant pathologies in oral cavity. Submental neck node mass due to thyroglossal duct cyst carcinoma is a rare presentation. A 25 year old female presented with a sub mental neck node which was noticed for 6 weeks with no history of fever or any oral lesions. On examination, there was a 1 × 1 cm non tender, firm, mobile sub mental neck node. Fine Needle aspiration cytology (FNAC) of the submental node showed features of metastatic papillary carcinoma from thyroid. Whole body Technitium 99 Pertechnate scan was done to find the primary site and metastases in other neck nodes but failed to find any. After necessary investigations, Total thyroidectomy with sistrunk’s procedure, central compartment clearance and level I clearance, was done.  Histopathology report showed papillary carcinoma arising from Thyroglossal duct with metastases in submental lymph node. Different pathologies of a mass occurring in submental area are reactive lymphoid hyperplasia, non-Hodgkin lymphoma, dermoid cyst, abscess, sarcoidosis, hemangioma, and lipoma. Neck mass in submental area occurring due to metastases from thyroglossal duct cyst carcinoma without the swelling in primary is a rare presentation.</p>