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Sudden Sensorineural Hearing Loss (SSNHL) is described as a hearing loss of at least 30db in three frequencies in pure tone audiogram over 3 days or less. The cause may be infectious, vascular, systemic immune-mediated or idiopathic. Multiple viral infections have been associated with SSNL. However, dengue fever, which is an RNA viral disease that is directly transmitted by a mosquito of genus Aedes, has been reported to present with SSNHL only thrice in existing literature to the best of our knowledge. There are multiple different proposed mechanisms of SSNHL in viral infections and multiple viruses have been proven to cause hearing loss. However, dengue virus is not one of them. In majority of cases of SSNHL, the exact cause is very difficult to determine. We report the case of a gentleman who had unilateral SSNHL after dengue fever.

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INTRODUCTION: The best initial investigation for thyroid nodule is fine needle aspiration (FNA). Bethesda System is an international standardized system of reporting thyroid nodules and recommends subsequent management. Every institution should assess the risk of malignancy in each category to avoid unnecessary thyroid surgeries, with this aim we conducted a review at our center to calculate risk of malignancy in each category. MATERIALS AND METHODS: Retrospective 9-year (2009-2018) review of thyroid FNAs done at a tertiary care Centre. The FNA was stratified according to The Bethesda System. Histopathology reports of the operated cases were used to evaluate the cytology for diagnostic accuracy. RESULTS: There were 495 patients who underwent thyroidectomy. The mean age of the cohort was 42.51 +/- 13.2 years and 387 (78.2%) were females. The frequency of Bethesda categories I, II, III, IV, V, and VI were 9.1%, 55.6%, 16.4%, 6.5%, 9.3%, and 3.2% respectively. Malignancy rate in operated thyroid nodules were 37.8%, 8.4%, 33.3%, 50.0%, 89.1%, and 100% for Bethesda categories I to VI, respectively. The sensitivity, specificity, negative predictive value and positive predictive value and their 95% CIs were calculated as 81.30 (73.28 - 87.76%), 77.06 (72.12 - 81.51%), 91.64 (88.3 - 94.1%) and 57.14 (51.79 - 62.33%). The overall diagnostic accuracy was 78.22 (74.12 - 81.95%). CONCLUSIONS: All the Bethesda categories showed greater malignancy risks than other reported studies. Knowledge of local rates of malignancy is important to accurately predict the risk of malignancy even when reported with internationally accepted nomenclature like the Bethesda System.

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The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only usage and high cost of involved in such trainings, experts have developed newer techniques of training, including three-dimensional reconstruction models and virtual reality simulators. Most of the literature on simulation in training of residents focuses on anatomical understanding and development of the surgical technique. There has been significant improvement in these techniques over time. With the addition of haptic feedback in the newer virtual simulation models, simulation has edged closer to basic modules of temporal bone dissection. the current review article was planned to have an overview of the different techniques in detail that are currently being in used.

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Locoregional recurrence accounts for majority of the treatment failures in oral cancer patients. Current study aimed to determine the predictors of recurrence and survival in patients with biopsy proven Squamous Cell Carcinoma (SCC) of the oral cavity. This study included 88 patients of squamous cell carcinoma treated at our institution from 2007 till 2013. Primary intervention was surgery in all patients with radiation and chemotherapy in selected patients. Primary end point was locoregional recurrence, distant metastasis and death. Out of 88 patients, 23 (26.1%) patients developed locoregional recurrence and 6 (6.8%) patients developed distant metastasis. Overall survival rate was 77.3%. Follow up ranged from 1 month to 63 months with mean of 17.8±16.2. On multivariate analysis, lymph node involvement and loco-regional recurrence were independent parameters related to decrease overall survival. Lymphovascular invasion, perineural spread, TNM stage and lymph node involvement had significant impact on recurrence.

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The aim our study was to determine the accuracy of frozen sections in oral cancer resections. Patients who underwent oral cancer resection at Patel Hospital were included in the study. Tissues for frozen sections were obtained from the mucosal margins and tumour bed. Frozen sections were compared with the paraffin embedded sections which served as the gold standard in our study. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and kappa statistics were calculated. A total of 299 frozen sections were obtained from 77 patients who underwent oral cancer resection, mean (3.88±0.76). Frozen sections' sensitivity in relation to permanent sections was 72.7% and specificity of 93.9%. The overall accuracy of the test was 90.9%. Kappa value was calculated to be 0.642, which showed a moderate agreement. Frozen sections are accurate enough to be used in assessing intraoperative margin assessment for tumour clearance.

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