A 27 year old female attended our ENT out patient department with swelling in the left preauricular region. Excision biopsy was done and was reported as pilomatrixoma. Pilomatrixoma is a rare tumor in head and neck region. It is commonly misdiagnosed and often missed while making a differential diagnosis. It is a benign tumour but occasionally it may become malignant. For this reason surgical excision is the treatment of choice.

Objective: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management. Methods Study Design:  Prospective observational study Setting:            Tertiary Government Medical College and Hospital Subjects:          64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing, using descriptive statistics and chi-square tests.  Results: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (χ2 = 23.30; p=.00001) as well as with size of perforation ((χ2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ≤50%  [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((χ2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection. Conclusions: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors, with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings. Keywords: tympanic membrane perforation, tympanic membrane, risk factors, wound healing, early intervention

Introduction: A synchronous second primary malignancy as squamous cell carcinoma of external acoustic meatus following basal cell carcinoma of cheek is reported with their management and review of literature. Case Report: Pigmented basal cell carcinoma of cheek was managed successfully by wide local excision followed by flap reconstruction and subsequently diagnosed squamous cell carcinoma of external acoustic meatus by concurrent chemoradiation after initial surgical debridement. Conclusion: Second primary malignancy as squamous cell carcinoma of external ear canal is rare after basal cell carcinoma of cheek though there is anatomical vicinity. Surgery in case of basal cell carcinoma and concurrent chemoradiotherapy in case of external ear canal squamous cell carcinoma is the mainstay of treatment.

Background: Nodular thyroid is a common occurrence affecting 5% of the population. Aims and Objectives: To find the prevalence of thyroid nodules, to study the clinico-biochemical profile of the patients with thyroid nodules and to establish a correlation between pre-operative ultrasonography and fine-needle aspiration cytology (FNAC) with post-operative histopathologic findings. Materials and Methods: A prospective observational study was conducted in a tertiary care hospital in Kolkata over 1.5 years. Patients with clinically detectable nodules posted for surgery were evaluated clinically, biochemically, ultrasonographically (USG), and cytologically with FNAC. Histopathologic examination (HPE) was done post-surgery. Comparison was done between those with benign and malignant nodules. Correlation was done between pre-operative USG, FNA, and post-operative HPE of the nodules. Results: Out of 322 cases during the study period, the prevalence of clinically detectable thyroid nodule posted for surgery was 39 (12.58%). Most of the patients were euthyroid (94.9%), had nodules in left lobe (41.5%). Most of the nodules were heteroechoic (56.5%) and majority were THY3 nodules (48.7%) on FNAC. On HPE, malignancy was found in 20.5% of the nodules. Compared to benign nodules, malignant nodules were more commonly larger, on the left lobe, solid, hypoechoic, with spiculated margins, punctate calcification, and having associated neck nodes (pall < 0.03). Out of 11 cases, which were radiologically predicted to be malignant, 10 had THY ≥3 on FNA, and 8 were malignant on HPE. USG had a sensitivity, specificity, positive, and negative predictive value of 87.5%, 87.1%, 63.63%, and 96.43% in predicting malignancy. Conclusion: Pre-operative ultrasonography for thyroid nodules can predict malignancy with sufficient sensitivity and specificity and can obviate the need for unnecessary FNAC in many cases and also suggest imminent need for surgery rather than FNAC in very high risk cases.

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