Department of ENT - Head & Neck Surgery

Beginning its Outpatient Department services in April 2023, the Department of ENT-Head & Neck Surgery, AIIMS Guwahati has taken a long road, currently extending its services in health care to special clinics, inpatient, elective and emergency operation theatre facilities. Services are being provided for better care in all common ENT and Head & neck ailments, challenging ENT diseases, and head and neck malignancies. The department is equipped with all the basic and modern diagnostic and therapeutic facilities.

Vision:

To be the center of excellence in ENT-Head &Neck Surgery by fostering comprehensive elective and emergency clinical care in the field and to be identified as the nodal center catering to the increasing head and neck malignancies in this part of the country. At the same time to be the leading venue in medical education and research in ENT -Head&Neck Surgery. To focus on strengthening screening programs for hearing impairment in neonates and general population and to offer Cochlear Implantation wherever feasible, thus to be a pioneer center for Cochlear Implantation and hearing rehabilitation.

Mission:

• To establish a center of excellence in health care, training, research, and medical education in ENT -Head & Neck Surgery.
• Looking forward to regularly upgrading the standards of ongoing post-graduation courses and establishing training in sub-specialties in Head & Neck Oncology; Skull base & Neurotology.
• The department would also aim to provide continuing education and professional development opportunities for practicing ENT specialists to ensure that they are up to date with the latest developments in the field.
• The department would also aim to be at the forefront of research. The research would focus on developing new innovative therapies and technologies in collaboration with other specialties.

Services Provided:

1. Out Patient Department (OPD) Services:

The department is running its OPD services since April 2023. OPD services are available on all days from Monday to Saturday. Various diagnostic and minor therapeutic facilities provided in OPD are as follows:

• Special Clinics:

      1. Head and Neck Tumor Board:

• In our devoted mission to provide comprehensive cancer care in Head & Neck Malignancies, tumor board discussions are conducted along with the department of Radiation Oncology on Tuesdays and Fridays every week from 12 pm to 1 pm. All diagnosed patients of head and neck malignancies are discussed in detail before a panel of experts in head and neck oncology and radiation oncology and their treatment modality is planned. Patient and caregiver counseling regarding the disease prognosis and treatment propose to go hand in hand with the tumor board discussions.

      2. Vertigo Clinic

• Patients with vertigo and balance disorders presenting to various OPDs in AIIMS Guwahati are brought under a single arm in our Vertigo clinic running on Wednesday and Friday since April 2024. Thorough symptomatic evaluation of individual patients, appropriate diagnostic audiovestibular tests, clinical positional and neurological tests, Canalolith repositioning maneuvers, vestibular rehabilitative exercises, and pharmacological therapy form the working sequence of the clinic. Radiological imaging and neurology/neurosurgical referrals are done in indicated cases. Thus, diagnosis and treatment of the challenging clinical spectrum of vertigo are effectively streamlined.

      3. Rhinology Clinic

• Currently in its early phase, the Rhinology clinic started off in September 2024.The activities of clinic is being currently limited to identifying, and diagnosing common as well as rare challenging nasal and anterior skull base ailments and discussing them in detail for effective medical/surgical interventions. The services of the clinic will be extended in the near future to allergy diagnostics and immunotherapy.

      4. Audiology, Speech and Language Pathology Services

           We have an efficient team comprising of an audiologist and a speech therapist involved in diagnostics and rehabilitation of hearing, speech, and language pathologies as well as swallowing disorders.

• Team : 

           1. Mrs. Tishya Joshi

           2. Mr. Kanhaiya Jha

The services provided include:

       1. Speech and Language Pathology Services:

• Our dedicated team provides Auditory Verbal Therapy(AVT) for Cochlear implantees pre- and post-surgery enabling early speech rehabilitation. Speech and voice disorders like those patients with vocal nodules, stuttering, stammering, dysarthria, neurological speech disorders and children with speech and language delay are offered therapeutic and rehabilitative speech training. Therapeutic swallowing maneuvers are also offered to those patients with neurological causes for dysphagia and those with trouble of aspiration.

       2.  Audiovestibular diagnostic and rehabilitation services:

• The audiovestibular test battery provided in the OPD includes: Pure Tone Audiogram (PTA), Impedance Audiometry, Brainstem Evoked Response Audiometry (BERA), OtoAcoustic Emissions (OAE), Special tests of hearing like SISI (Short Increment Sensitivity Index), Tone Decay Test, Vestibular Evoked Myogenic Potential (VEMP), Electrocochleography (ECogG).
  These investigative audiological test battery aids in the evaluation and treatment of all ailments related to hearing impairment presenting to our OPD as well as in the neonatal hearing screening. The vestibular tests are an addon to our diagnostic armamentarium in vertigo and other balance disorders.
   
• Endoscopy Services:
  
  Rigid Video laryngoscopy, Diagnostic Nasal Endoscopy, Otoendoscopy and Flexible Fiberoptic endoscopy are readily available in OPD, aiding in screening and early diagnosis in benign and malignant diseases of Head & Neck. Also, these assists in sampling the lesions for histopathological examination in many cases.
   
• Minor ENT Procedure Services:
  Our OPD is equipped for performing Minor ENT procedures under local anesthesia-like ear wax syringing, suction clearance of ear, ear canal biopsies, ear lobuloplasties, intratympanic steroid injections, biopsies from oral cavity and few oropharyngeal lesions, excision of small benign neck swellings, drainage of small abscesses, minor wound debridement, nasal packing for epistaxis, tracheostomy care and so on.

2. Medical Education and Academic Activities

• Post-Graduate Education Programme:
  Since the commencement of postgraduate courses in January 2024; Postgraduate learning and teaching have been of utmost priority in the department. Two academic sessions comprising of PG seminar and case presentations are being done every week. In the PG topic presentation on Wednesdays, high-yielding topics included in the PG curriculum and recent advances in the field of ENT and Head and Neck Surgery are discussed. Weekly case presentations are done on Saturdays, the cases discussed include those that are relevant to the final assessment in MS practical examination and rare clinical scenarios managed in the department. Active participation and guidance from the senior residents and faculties are ensured in these sessions for the optimal benefit of the junior residents.

  Ward rounds for the inpatients with detailed bedside clinical discussions are done on a daily basis.

  Attending the regional and national conferences supported wholeheartedly along with their participation in research presentations is encouraged. Periodic theoretical and practical assessment has been made a mandatory practice in the department

• Undergraduate Teaching:

  MBBS classes as per curriculum are done for students in their 4 th,6th and 7th Semesters with clinical postings to provide early clinical exposure to various ENT disorders and theory classes which include topic discussions, tutorials, Self Directed Learning (SDL) sessions and Integrated Teaching Programme (ITP) which invites participation of allied departments. The teaching and assessment schedules being followed strictly abide by the latest NMC recommendations.

3. Emergency Services:

• 24x7 emergency services are provided in the department; major emergencies attended include airway emergencies, deep neck space infections, epistaxis, foreign bodies of upper aerodigestive tract and acute infections of ear, nose and throat etc. Emergency operation theatres are also functional round the clock for patients who need urgent interventions.

4. In-Patient Facilities:

• ENT IPD for those patients requiring in-hospital care for ENT and Head &Neck disorders.

5. Operation Theatre Services:

• Elective ENT-Head&Neck Surgery OT services are available.

1. Routine Surgeries Performed:

   Head & Neck: Resection of oral cavity carcinomas with reconstruction (local and free flap), Neck dissection, Thyroid and parathyroid surgeries, Salivary gland excisions like submandibular gland excisions and Parotidectomies, Total Laryngectomy.

   Otology and lateral skull base: Cochlear Implantation, Tympanoplasty, Mastoid Explorations, Facial nerve decompression, Excision of cerebellopontine angle tumors

   Rhinology and anterior skull base: Functional Endoscopic Sinus Surgery, Endoscopic/open sinonasal tumor (JNA) excision, Endoscopic Medial Maxillectomies, Open Maxillectomy, Craniofacial resections, Endoscopic nasopharyngectomy (in Recurrent Nasopharyngeal Carcinoma (NPC)), Trans sphenoidal endoscopic surgery for pituitary lesions….

   Laryngology and airway: Micro laryngeal surgeries, Laryngeal biopsies, Cordectomy (Coblation assisted) for early glottic cancers.

2. Emergency Procedures:
   
   Tracheostomy, Laryngeal and pharyngeal repairs, Incision and drainage of deep neck space infections, wound debridement, Neck explorations for trauma, Endoscopic packing, cauterization and Sphenopalatine artery ligation for epistaxis.

6. Research and Publications

• Ongoing Research projects:

1. Study to assess postoperative outcomes of tragal perichondrium reinforced cartilage tympanoplasty in the mucosal type of chronic otitis media- An observational study.
2. Evaluation of pre-operative albumin globulin ratio (AGR) and prognostic nutritional index (PNI) and their impact on outcomes of oral cancer patients undergoing surgery at AIIMS GUWAHATI: A prospective study.
3. Study on the association of long-non-coding RNAs expression with cellular metabolites in head and neck cancer (with Department of Biochemistry)
4. Study on the expression of long non-coding RNAs and metabolic profile in oral cancer. (with Department of Biochemistry)
5. Study on the outcomes of nasopharyngeal carcinoma treated with node level 1B sparing radiation therapy by volumetric modulated arc radiotherapy technique. (with the Department of Radiation Oncology)
6. Study to evaluate the effectiveness of high-frequency audiometry (EHFA) and distortion product otoacoustic emission (DPOAE) in early detection of cochlear malfunction and hearing impairment in diabetic patients with normal hearing thresholds on conventional audiometry.
7. Expression of p16 and Alk in OSCC. (with Department of pathology)
8. Detection of BRAF-V 600E mutation in thyroid carcinoma by immunohistochemistry. (with Department of Pathology)

Publications from the department (2023-2024)

1. Radial Forearm Free Flap for Head and Neck Reconstruction: Our Experience and Outcome.
   Shunyu NB, Lynrah Z, Medhi J, Ronrang L, Akhtar H, Das DJ, Dorjee L, Medhi R, Sayoo C, Momin C. Radial Forearm Free Flap for Head and Neck Reconstruction: Our Experience and Outcome. Journal of Maxillofacial and Oral Surgery. 2024 Oct 29:1-5.
   DOI: https://doi.org/10.1007/s12663-024-02354-7
2. Non-Lip Splitting Approach for Reconstruction of Mandible- A Case Report of Giant Ameloblastoma of the Mandible.
   Shunyu NB, Biswas K, Chandran RR, Medhi R. Non-Lip Splitting Approach for Reconstruction of Mandible-A Case Report of Giant Ameloblastoma of the Mandible.Cureus.2024 Sep 24.
   DOI: https://www.cureus.com/articles/296393
3. Atypical presentation of oral and laryngeal tuberculosis in an adolescent.
   Medhi R, Akhtar H, Shunyu NB, Jamil M. Atypical presentation of oral and laryngeal tuberculosis in an adolescent. BMJ Case Reports CP. 2024 Aug 1;17(8): e261888.
   DOI: https://doi.org/10.1136/bcr-2024-261888
4. Deep Lobe parotidectomy
   Shunyu NB, Deep Lobe parotidectomy. Journal of current research in Otolaryngology.2024 June 04.
5. Defensive medicine: current trends, medicolegal implications, public backlash and the future of patient care.
   NP Nair, Akhtar H, Shunyu NB. Defensive medicine: current trends, medicolegal implications, public backlash and the future of patient care. Futuristic Trends in Medical Sciences ISBN: IIP Series, Volume 3, Book, Part, Chapter
6. Comprehensive ENT Clinical Manual for MBBS Students
   Shunyu NB,Goyal A,Akhtar H,NP Nair. Comprehensive ENT Clinical Manual for MBBS Students. Textbook. 2023.May 5.
7. Vascularized Osteomyocutaneous Fibula Free Flap for Oromandibular Reconstruction: Outcome Analysis and Experiences of One Center.
   Shunyu, N.B., Ronrang, L., Medhi, J. et al. Vascularized Osteomyocutaneous Fibula Free Flap for Oromandibular Reconstruction: Outcome Analysis and Experiences of One Center. J. Maxillofac. Oral Surg. (2023). https://doi.org/10.1007/s12663-023-01982-9
8. Profile and perspectives of patients with hearing impairment: experience of a hearing camp conducted in rural Assam.
   Akhtar, H., Shunyu, N. B., Khound, M., Kaushik, J. S., Bhattacharyya, H., & Jamil, M. (2024). Profile and perspectives of patients with hearing impairment: experience of a hearing camp conducted in rural Assam. International Journal Of Community Medicine And Public Health, 11(7), 2703–2709. https://doi.org/10.18203/2394-6040.ijcmph20241827
9.  Management of Giant Frontoethmoid Osteoma by Combined Approach.
   Shunyu N B, Akhtar H, Deka A, et al. (October 15, 2023) Management of Giant Frontoethmoid Osteoma by Combined Approach. Cureus 15(10): e47046. doi:10.7759/cureus.47046
10. An Unusual Case of Post-Operative Functional Stridor After Emergence from General Anesthesia
    Deb P, Ahmed J, Akhtar H, Dutta K, Yunus M. An Unusual Case of Post-Operative Functional Stridor After Emergence from General Anesthesia. Cureus. 2023 Jul 12;15(7): e41757. doi: 10.7759/cureus.41757. PMID: 37575817; PMCID: PMC10416135.
11. Scholarly Community towards Open Source.
    Barman, E., Barman, B., Jamil, M, & Akhtar, H. (2023). Scholarly Community towards Open Source. Journal of Clinical Research and Applied Medicine, 3(1), 1–4. https://doi.org/10.5530/jcram.3.1.1
12. Salvage Endoscopic Nasopharyngectomy for Locally Recurrent T1 and T2 Nasopharyngeal Carcinoma.
    Shunyu NB, Lynrah Z, Medhi J, Aktar H, Syiemlieh J, Lyngdoh N. Salvage Endoscopic Nasopharyngectomy for Locally Recurrent T1 and T2 Nasopharyngeal Carcinoma. Indian Journal of Otolaryngology and Head & Neck Surgery. 2023 Sep;75(3):2688-93.

Departmental Activities 2023-2024

1. Regular Health Camps: The ENT-Head & Neck Surgery department is an integral part of all the health camps conducted in and around Kamrup District. This helps in expanding our diagnostic and therapeutic services to remote areas of the state.
2. Routine screening camps for Oral cavity carcinomas: Considering the high incidence of oral cavity malignancies in the state, screening for lesions and their early biopsies are being aided by screening camps regularly conducted in association with the Department of Community and Family Medicine.
3. Annual observation of World Hearing Day, on 3rd March.

•  ​2023: A hearing screening camp was organized for school children in the district for early identification of hearing loss in school students in this part of the state. A Poster competition organized on the theme of World Hearing Day was organized for MBBS students.
• 2024: Routine ear check-up camp along with hearing aid distribution was done and around 100 hearing aids were distributed to eligible beneficiaries.

4. Department organized Hands on Temporal Bone Dissection workshop on 1st November 2023.
5. Released book titled: Comprehensive ENT Clinical Manual for MBBS Students in May 2023.
6. Neonatal hearing screening programme in association with the Departments of Paediatrics&Neonatology and Obstetrics & Gynecology abiding with the National Program for Prevention and Control of Deafness (NPPCD) enables early identification and intervention in neonates with hearing loss.

Upcoming Services

1. Videonystagmography as an add-on to the pre-existing Vertigo clinic facilities.
2. Allergy clinic and Immunotherapy services.
3. Temporal Bone Dissection lab for residents.
4. Diagnostic evaluations for swallowing disorders.