bluuebunny/crossref_metadata_2025 huggingface dataset:
A CASE OF ORAL MUCOSAL MALIGNANT MELANOMA IN DISGUISE OF CERVICAL METASTATIC LYPMHADENOPATHY WITH APPARENTLY UNKNOWN PRIMARY.
Authors: Mozumder Somesh , Dubey Shirish , Dam Aniruddha , Bhowmick Anup Kumar
Published: August 2020

Introduction: Primary malignant melanoma of the oral cavity is a rare neoplasm. The tumors tend to metastasize or locally invade tissue more readily than other malignant tumors in the oral region.

Case Report: A 55 year old male presented with left sided hard cervical lymphadenopathy with unknown primary with cytology of malignant melanoma. 18FDG-PET-C.T scan helped identification of the primary.

Discussion: The survival of patients with mucosal melanomas is less than for those with cutaneous melanomas. Tumor size and metastases are related to the prognosis of the disease. Early oral malignant melanomas can be clinically very difficult to distinguish from other benign oral pigmented lesions.

Conclusion:  Any case presenting with cervical lymphadenopathy with a cytological diagnosis of Malignant Melanoma and without clinically identifiable primary, early detection using whole body 18FDG-PET CT is utmost important.
Recurrent Acute Tonsillitis, The 'Core' Issue
Authors: Samaddar Saikat , Mukherjee Dipanshu , Nandi (Mitra) Anita , Mandal Shyam Sundar , Roy Nirmalya , Sanyal Shaoni , Banerjee Swagatam , Bandyopadhyay Saumendra Nath
Published: August 2020

Introduction:

Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.

 Materials and Method:

A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically.

Result:

There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre.

Discussion:

The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks.

Conclusion:

Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population.
Vertigo, can it be redefined?
Authors: Choudhury Bhabani Kumar
Published: August 2020

Background & Objectives-

Vertigo, a clinical symptom complex is not infrequent in our patients. Its diagnosis too is controversial. Majority of these cases run from hospital to clinics, some times to Otolaryngologists to get rid of this bizarre experience. Sometimes they get benefit but otherwise they experience a destitute life.

Our aim was to treat them by Physical Therapy in the light of Cervical Spondylosis that is commonly associated with vertigo.

Material & Methods-

This is a prospective case study done in PMR department (OPD) of a teaching institute over a period of 6 months time period. 20 OPD patients of both sexes (14 ladies and 6 gents) with definite Cervical Spondylosis along with complain of vertigo or dizziness, pain at cervical spine were accounted for the study. Only extreme aged persons or patients with other major co-morbidity were excluded. These 20 patients were treated with conventional Physical Therapy for CS. Medications were prescribed as and when required.

Results-

After Physical Therapy, that included lifestyle modification, isometric cervical exercise, intermittent cervical traction, application of Therapeutic Ultrasound (UST) to cervical region and proper posture care of cervical spine along with use of cervical orthosis (where needed), majority of the patients become symptom free.

Conclusion-

Physical Therapy may be considered as an alternative method of treatment of Vertigo patients, who are otherwise not responding satisfactorily to pharmaceutical agents.
Large Neurilemmoma of Buccal Mucosa in a Child – A Rare Entity
Authors: Dutta Sirshak , Aggarwal Neeraj , Choudhury Avijit , Sinha Ramanuj
Published: August 2020

Introduction: Neurilemmoma or Schwannomas are benign tumour arising from the nerve sheath of myelinated nerve. Head neck neurilemmomas are not uncommon but intraoral region is very uncommon for this type of tumour.

Case Report: A very rare case of buccal neurilemmoma in an eleven year old child, but much larger than other reported case is reported in the present article with review of literature.

Discussion: Among the intraoral subsites, very few cases of neurilemmoma are reported to be situated in the buccal mucosa. Diagnostic dilemmas due to Fine needle aspiration cytology with features often resembling that of pleomorphic salivary adenomas are reported. The size of the tumour was larger than the cases reported in literature till date. The age of the patient was also much younger than the other reported cases, which made the present case unique.
Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Thyroid Swellings
Authors: Kumara Rama Sarath Babu , Raju Rathan , Radhakrishnan Shankar
Published: August 2020

Introduction

Fine needle aspiration cytology (FNAC) is now being accepted as the most cost-effective, minimally invasive technique with very low incidence of complications in the diagnosis of most of the thyroid lesions with an added advantage of segregating the patients of solitary thyroid nodule (STN) into operative and non-operative groups.

Materials and Method

A prospective longitudinal study was undertaken over a period of one year (2015) at the out-patient department of a medical college hospital in Tamil Nadu to determine the accuracy of FNAC in terms of sensitivity, specificity, positive predictive value and negative predictive value in comparison with histopathology in the diagnosis of a thyroid swelling. Patients with solitary thyroid nodule, in euthyroid state without serious medical disorders were included in our study. FNAC was performed with 23G needle, smears were fixed with ether-95% alcohol solution, and staining was performed using Papanicolaou’s stain. The thyroid specimen which was excised during the thyroidectomy procedure was processed in automated tissue processing units and sent for histopathological examination.

Results

The validity of FNAC in terms of sensitivity and specificity was assessed by comparing it with the histopathological examination. The sensitivity of FNAC in detecting all the benign and malignant type of thyroid lesions was found to be in the range of 80-100%, whereas the specificity and the positive predictive value was almost 100% and the negative predictive value was between 98-100%, for all the lesions detected by FNAC. The accuracy of detection of lesions through FNAC is almost 94%.

 

Conclusion

The use of FNAC has reduced the number of patients with solitary thyroid nodules undergoing unnecessary surgery and has led to proper planning of surgery in malignant cases.
An Asymptomatic Pointed Foreign Body in the Hypopharynx-A Rare Case Report
Authors: Das Jyotiranjan , Ghosh Debangshu , Saha Jayanta , Basu Sumit Kumar
Published: August 2020

Introduction

Foreign body ingestion is an ENT emergency frequently encountered in both children and adults.

Case Report

A case of an open safety pin in the hypopharynx in a fifteen year old boy is reported, which remained impacted there for the past 15 days without any significant symptom or complication. CT scan, performed before surgical intervention, did not show any migration of this foreign body from its intraluminal site. This was removed by ‘Magill forceps technique’. Postoperative period was uneventful.

Conclusion

Pointed foreign body may present with negligible symptoms and that too may stay in the cricopharynx for long without migration. Magill forceps technique can be a good surgical option in such cases.
Double nail in Hypopharynx- A rare presentation
Authors: Banerjee Pranabashish , Kundu Rajesh Kumar , Ray Dhrupad , Das Gautam
Published: August 2020

Introduction

An extremely rare case of a pair of nails impacted in the right pyriform sinus, presenting 72 hours after the incident, is reported.

Case Report

X-ray soft tissue neck revealed the presence of a pair of nails in the neck at C4-C5 vertebral level. The foreign bodies could not be seen on hypopharyngoscopy due to severe mucosal oedema. Lateral pharyngotomy was done to remove the nails with C-arm guidance.

Discussion

Retained foreign bodies in the aerodigestive tract are known to produce complications. Delayed presentation makes the management difficult. C-arm guidance during surgical exploration is helpful to locate a radiopaue foreign body in difficult situations.
Intralesional Sclerotherapy with Polidocanol in the Management of Head and Neck Vascular Lesions
Authors: Das Arindam , Sengupta Anindita , Ghosh Debashis , Bose Deepjoy , Dhara Subhadip , Sengupta Arunabha
Published: August 2020

Introduction

Vascular lesions (Hemangioma or vascular malformation) in the head and neck region are quite common and need therapeutic intervention if they become symptomatic or cosmetically unacceptable. Different therapeutic modalities including cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgery and/or embolization are available. Advances in laser surgery as well as sclerotherapy techniques have improved our ability to treat extensive lesions. Surgical excision sometimes becomes very difficult due to massive per-operative bleeding and proximity to major neurovascular structures. In this study we have tried to find a simpler, easily available, safe and cost-effective therapy to treat these vascular lesions.

Materials and Method        

A pilot case study was conducted in a tertiary care hospital in Kolkata for a period of one year. Polidocanol was selected as the sclerosing agent for treatment of head and neck vascular lesions for its safety and its local anesthetic effect. 3% Polidocanol was injected in 20 lesions.

Result

20 patients with head and neck vascular lesions treated with polidocanol sclerotherapy were followed up for 12 months. The study included 20 patients (12 female and 8 male) with mean age 20.3 years (range 6-62 years). Of these 20 patients 14 had 90% to 100% result and in 6 patients we obtained only mild improvement.

Discussion

Sclerotherapy is now becoming the first choice of treatment in head and neck vascular lesions. Polidocanol is a mixture of 5% ethyl alcohol and 95% hydroxypolyethoxydodecane, the detergent action of which induces a rapid overhydration of endothelial cells, leading to vascular injury and regression of vascular lesions. As the same time it is a local anesthetic, so treatment is painless.

Conclusion

It is a less invasive, cost effective, painless OPD based management for head and neck vascular lesions having good functional and aesthetic outcome.
Study of Asssociation of Concha Bullosa with Rhinosinusitis
Authors: B H Shrikrishna , A C Jyothi
Published: August 2020

Introduction

There are several studies with contradictory findings about the role of concha bullosa with predisposition to rhinosinusitis. This study was conducted to assess the relationship of osteomeatal unit blockage with concha bullosa.

Materials and method

A cross-sectional observational study by radiological assessment of prevalence of chronic rhinosinusitis and blockage of ipsilateral osteomeatal unit was done on 100 cases of concha bullosa detected on computed tomography to determine the prevalence of chronic rhinosinusitis in subjects with concha bullosa and to examine the latter’s relationship to osteomeatal unit blockage, which is a precursor for rhinosinusitis.

Result

One hundred cases of concha bullosa were studied in a total of 87 CT scan films depicting concha bullosa. Some CT scans showed unilateral concha bullosa while few scans showed bilateral concha bullosa. Ipsilateral rhinosinusitis was found in only 31% of the sides in scans of subjects with concha bullosa. Of the total 100 concha bullosae studied, extensive type was the commonest followed by bulbous and lamellar variety.

Discussion

Although rhinosinusitis was more predominant in the extensive type of concha bullosa compared to other types, it was statistically not significant and there was no statistically significant association between any type of concha bullosa with ipsilateral rhinosinusitis either in right side or left side.

Conclusion

This study has found no statistically significant association between any type of concha bullosa with rhinosinusitis. A bigger study with larger sample size is required to better assess the strength of association between concha bullosa and rhinosinusitis.
Reliable technique of Endoscopic Dacryocystorhinostomy – A Pilot Study
Authors: Das Sudip Kumar , Das Chiranjib , Maiti Amit Bikram , Guha Ruma , Chowdhury Subhendu
Published: August 2020

Introduction

Over last two decades endoscopic dacryocystorhinostomy has gained popularity over external dacryocystorhinostomy for post-canalicular obstruction. But the success rate is not very satisfactory. Our objective is to describe a technique where near 100% success can be achieved.

Materials and Methods

The study was conducted on 92 patients over 4 years and 6 months. The technique we describe involves creation of a large ostium, creation and apposition of nasal and lacrimal sac mucosal flaps. All the patients were under regular follow-up for12 months after operation. We also compared our result with other techniques.

Results                                       

The neo-ostium was well healed and free flow of normal saline was seen in 90 cases (97.83%) post-operatively. In one case there was ostium fibrosis and in another case granulations were seen.

Conclusion

For the past few decades many approaches have been tried for endoscopic dacryocystorhinostomy. But the long term success rates have not been satisfactory. Our technique of creating large stoma and proper mucosal apposition, when done properly gives near 100% success.
Review of the Multidisciplinary Voice Clinic in a District General Hospital of the United Kingdom
Authors: Evans Louise Marie , Beca Parry Haf , Patterson Helen , Mohan Alagar Chandra
Published: August 2020

Introduction

The Voice Clinic is a multidisciplinary specialist voice clinic. Our aim is to review patient demographics, subjective symptoms both at presentation and 16 months post clinic and patient satisfaction.

 

Methods

A retrospective review of all pre treatment voice clinic questionnaires for all new patients who attended the voice clinic over a 3-month period. A telephone interview was conducted 16 months after first presentation to determine patient satisfaction and whether patient’s symptoms had improved. 

 

Results

A total of 25 patients who had completed a pre clinic questionnaire were identified, 17/25 completed the follow up interview. 88% of patients reported symptoms of ≥ 6 months duration. 41% underwent Speech and Language Therapy (SALT), 24% had medical management, 6% surgery, and 30% were given advice only. On a severity scale of 1- 10 (10 most severe) 40% rated their voice severity to be ≥5/10 at presentation, 16 months later this was 11% of patients.  56% rated the impact of their voice on their life to be ≥ 5/10 at presentation, 16 months later this was 6%.

 

Conclusion

 

Although limited the review shows that for the majority of patients their symptoms and quality of life improved after review at the multidisciplinary clinic.
Use of Nasal Obstruction Symptom Evaluation Scale in Objective Evaluation of Symptomological Improvement in Post Septoplasty Patients
Authors: Saha Mukulika , Banerjee Shoham , Hembrom Rabi , Sen Indranil
Published: August 2020

Introduction

The complaint of nasal obstruction or difficulty in nasal breathing is highly subjective. Benefits of Septoplasty, as perceived by the patient, also varies widely with subjective satisfaction ranging from complete alleviation of symptoms to a total failure.

Materials and Methods

Fifty three patients above 18 years of age, with anatomical deviation of the nasal septum as the sole cause of obstruction and symptoms persisting for more than 3 months, underwent septoplasty. Nasal endoscopy was done for Mladina typing of the nasal septal deviation. Pre and post operative NOSE (Nasal Obstruction & Symptom Evaluation) score were analysed.

Results

Mean preoperative NOSE score was 11.98 ±1.23. On the 6th and 12th postoperative week follow up NOSE score was 3.13±1.30 & 1.05±0.87 respectively with p value <0.05. 

Conclusion

Mladina typing along with NOSE score will help in letting the patient know about his or her expected outcome following septoplasty.
Medical Negligence : An Overview
Authors: Dey Bratin Kumar
Published: August 2020

Medical professionals are treated as next to God. They provide humanitarian services and gives solace to individuals suffering from various diseases and disorders. Due to their great service to humanity, the doctors and medical professionals are treated with reverence and since the ancient times the medical profession has been considered as a noble profession. However with the passage of time, there has been a change in the doctor - patient relationship. During the last few decades a number of incidents have come to light in which the patients have suffered due to the error and inadvertent conduct of doctors. Due to the increasing conflicts and legal disputes between the doctors and patients, most of the legal systems have developed various rules and principles to deal with such inadvertent behavior of doctors. This has led to the development of a new branch of jurisprudence, i.e. medical negligence. Hence, any negligence on part of the medical professional would be treated as either a tort of negligence or a deficiency in service under Consumer Protection Act, 1986. As the profession involves the idea of an occupation requiring purely intellectual skills or of manual skills controlled by the intellectual skill of the operator, it is distinctively different from an occupation, which is substantially production or sale or arrangement for the production or sale of commodities. Medicine is a highly complex domain. It is difficult for consumer laws to review medical negligence cases with flawless technical clarity and accuracy. Thus medical negligence is not purely a matter of consideration for judiciary but also the technical inputs of specialized experts in the field have substantial weightage while deciding the case of medical negligence against doctors. The present paper is devoted to introvert inspection of negligence in medical profession in the light of existing laws with more emphasis on the interpretation of consumer protection law by judiciary.
Total Laryngectomy in Laryngeal and Hypopharyngeal Malignancy
Authors: Shetty Hamsa , S Sridhara , KS Gangadhara
Published: August 2020

Introduction

Advanced laryngeal and hypopharyngeal malignancies are associated with significant morbidity and mortality for the patients with associated financial burden for the society. Recommended treatment for such malignancies includes total laryngectomy or total laryngectomy with partial pharyngectomy  with or without neck dissection, radiotherapy (RT) alone or surgery followed by radio therapy and combined chemotherapy (CT) with radiotherapy (CCRT).

Materials and Methods

This retrospective study was conducted over a period of 5 years, in a tertiary care institute with aim to study the incidence of laryngeal and hypopharyngeal malignancy over a period of 5 years in a tertiary  care institute, to assess the proportion of patients who agreed to undergo the proposed modality of treatment with surgery and post-operative radiotherapy,  to note the post operative complications and also to assess the 5 year survival of the patients who completed the prescribed regimen.

Result

This study highlights the large gap between the high incidence of this disease (a total of 170 cases of laryngeal and hypopharyngeal malignancy diagnosed in our hospital over a five year period ) and the  low turnover of   patients actually undergoing surgery for the same (8 out of 38 patients who were advised surgery underwent the same).

Discussion

Vast majority of laryngeal and hypopharyngeal malignancies are squamous cell carcinomas. Though 47 proved cases of hypopharyngeal malignancy and 36 proved cases of laryngeal malignancy were assessed, only 8 patients agreed to undergo surgery, indicating a large disparity between disease burden and treatment beneficiaries, despite an excellent 5 yr survival rate.

Conclusion

The results of this study  emphasized the need for increased awareness regarding the favourable surgical outcome  when associated with post-operative radiotherapy. A very high five year survival rate can be achieved by combined modality treatment. Late presentation and lack of awareness about the disease are significant hindrances for management of laryngeal and hypopharyngeal malignancy.
Endoscopic Management of Inverted Papilloma Using CT Scan as the Predictor of Tumour Origin
Authors: Roy Ravi , Bhalla Vijay , Mathur Ankit , Ramakrishnan N
Published: August 2020

Introduction

Inverted papillomas are notorious for recurrence. The surgical cause attributed to recurrence is failure to achieve good surgical exposure and inadequate clearance of disease. Pre-operative prediction about the site of origin by CT Scan may contribute to a better surgical outcome. This study was undertaken to assess if focal hyperostosis on pre-operative CT scan can be considered to be a predictor of the site of tumour origin and correlate with endoscopic finding of the site of origin.

Materials and Method

 A prospective descriptive study was carried out between Jan 2014 and May 2016. Fifteen patients of histopathologically proven inverted papilloma that reported during this time period were evaluated using contrast enhanced CT Scan and subsequently underwent endoscopic excision of tumour identifying the tumour origin. Assessment of age, gender, symptoms, pre-operative staging, location of the tumour origin on CT Scan and surgical correlation of origin was done. Post-operative follow-up was done at 1 month, 3 months and 6 monthly thereafter.

Results

Six (40%) were classified as Krouse II and nine (60%) were classified as Krouse III. 12 (80%) arising from maxillary sinus, 02 (13.3%) arising from maxillary sinus and anterior ethmoids and 01 (6.7%) from sphenoid. Thirteen (86.7%) cases CT scan could predict the tumour origin which was confirmed during surgery. All cases managed by endoscopic technique with no recurrence or co-existence of malignancy.

Discussion

Focal hyperostosis in the walls of paranasal sinus is seen to be associated with IP tumour origin, the cause of which is not fully understood. It is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment.

Conclusion

CT scan is a good predictor of tumour origin and a conservative endoscopic approach can be planned accordingly for complete clearance of disease.
Intratympanic Methylprednisolone Injection as First Line Therapy for Idiopathic Sudden Sensorineural Hearing Loss
Authors: Patar Mukul , Sangma Rupanjita
Published: August 2020

Introduction

Steroid therapy is considered to be the gold standard for sudden sensorineural hearing loss (SSNHL). Delivering steroids by intratympanic injection is more efficient than systemic injections with minimum or no side effects. The present study was aimed to evaluate the efficacy and safety of intratympanic methylprednisolone injections as initial first line therapy for unilateral idiopathic SSNHL and the ease of giving it by otoendoscopy.

Materials and Methods

A prospective analysis was performed for the patients diagnosed as unilateral idiopathic SSNHL from April 2014 to April 2016 and receiving intratympanic steroids injections as first line therapy. Patients with unilateral sensorineural hearing loss of at least 30 dB at 3 contiguous frequencies occurring within a period of not more than 3 days are only included. All of the intratympanic steroid (ITS) injections were administered as OPD procedures. Each patient was treated by 3 injections given at 3 days interval. 

Results

A total of 22 patients who underwent primary intratympanic steroid (ITS) injection for unilateral SSNHL during the study period were included in the study. The mean age was 42.22 years (+ 9.79) and age ranged from 27 to 68 years. Patients included in our study came within 2nd to 27th day of occurrence of deafness and the mean duration (days) from onset of disease to start of ITS was 7.86 days. The average hearing gain in our study was 44.22 dB. In the present study 11 patients (50%) showed complete hearing improvement and 10 cases (45.45%) had partial and one (4.54%) showed no hearing recovery at 3 weeks follow up period.

Conclusion

Minimal systemic absorption with minimum or no systemic effects and high percentage of success rate encouraged the surgeons to prefer ITS as primary therapy for idiopathic unilateral SSNHL. It is effective, cheap, well-tolerated and can be performed as OPD procedure.
Simultaneous Bilateral Type I Tympanoplasty as a Day Care Procedure
Authors: Sahu Abhishek Vijay , Datta Dhrubajyoti , Talukdar Jeumon , Dutta Narendranath
Published: August 2020

Introduction 

Bilateral same day type I tympanoplasty scores over unilateral type I tympanoplasty in terms of convenience and conservation of resources but, it is rarely performed because of theoretical risk of postoperative sensorineural deafness.

Materials and Methods

A total of 60 patients with central perforation of tympanic membrane of both ears were included in this study. Thirty patients had undergone unilateral type I tympanoplasty and an equal number of patients were treated with bilateral type I tympanoplasty in the same sitting. The results were compared to evaluate the advantages and efficacy of single sitting bilateral type I tympanoplasty with unilateral type I tympanoplasty.

Result

Perforation closure was successful in 94.6% and 93.3% ears while hearing improvement in 82.1% and 86.6% in group I (bilateral tympanoplasty) and group II (unilateral tympanoplasty) respectively. Mean hearing gain for successfully operated ears in group I (both left and right) and group II is 18.1 dB and 16.5 dB. None of the patients developed iatrogenic sensorineural hearing loss.

Discussion

Bilateral perforations of the TM is a common finding and CSOM is found to be the most common cause in more than 90% of patients. The outcome of bilateral single stage tympanoplasty is sparse in the literature. Most of the reports pertain to unilateral operations with average success rates of about 60–100 %.

Conclusion

Single sitting bilateral type I tympanoplasty by transcanal routes is safe day care procedure with a high success rate.
A Rare Presentation of Cavernous Hemangioma of Both Inferior Turbinates
Authors: Salimath KN , Ramakrishnan N , Galagali JR
Published: August 2020

The nasal cavity presents with various types of neoplasms, including epithelial and mesenchymal tumors. Cavernous hemangioma of nasal cavity is quite rare. It usually presents as a unilateral mass arising from mucosa of nasal cavity.

Case Report                                      

We describe here, a case of 25-year-old serving soldier, who was referred to our hospital with a mass in both nasal cavities with bilateral nasal obstruction. On examination, the mass originated from the inferior aspect of inferior turbinate of both sides. Subsequently on histological examination after complete endoscopic excision revealed that the mass was a cavernous hemangioma arising from both inferior turbinates.

Discussion

To our knowledge, this is the first case of cavernous hemangioma arising from both inferior turbinate reported in literature.
Recurrent Parotitis due to Parotid Duct Calculi
Authors: Banerjee Pranabashish , Barman Debasis , Pakira Braja Ballav
Published: August 2020

Introduction

Recurrent parotitis is frequently encountered in Otolaryngology practice. Parotid calculi, however is extremely uncommon as compared to submandibular calculi. Hence parotid duct calculi as a cause of recurrent parotitis need a special emphasis.

Case Report

We present here a rare case of recurrent parotitis due to parotid duct calculi in a 35 yr old female patient, who initially had presented to ENT OPD with recurrent pain and swelling for last eight months. Clinical examination was suggestive of calculi in the left parotid duct area which was confirmed by relevant radiological evaluation including USG, CT scan and parotid sialography. Patient was treated by superficial parotidectomy along with removal of the calculi from the parotid duct. 

Discussion

Calculi arising from the submandibular duct and gland are well established and quite easy to diagnose, but parotid calculi are quite unheard of in clinical practice. According to Western literature, parotid calculi account for 15-20% of all salivary gland calculi. We present here the case along with the relevant review of the literature.
Does Nasal Obstruction Increase Heart Rate?
Authors: Keshavamurthy Venkatesha Belur , Shekharappa Munish Kambathatti , Beesanahalli Yogeesha , Maradi Nagaraj , Kori Priya Rani
Published: August 2020

Introduction 

Nasal obstruction is implicated in the etiopathogenesis of Obstructive Sleep Apnea (OSA). OSA is associated with mean heart rate (HR) variations in wakefulness and in sleep. Early intervention has proven to reduce cardiovascular morbidity in OSA patients. In spite of various confounding factors HR measurement has been utilised as an independent predictor of mortality. The influence of severity of nasal obstruction on HR has not been studied in the literature. This study aims to clarify the influence of severity of nasal obstruction on HR.

Materials and Methods

We examined 55 patients aged less than 50 years with no previous cardiac complaints, who underwent overnight oxygen saturation and HR monitoring. The patients were divided into Mild, Moderate and Severe Nasal Obstruction group depending on NOSE scale grading.

Results

There was no statistically significant difference in the Mean HR, Min HR, Max HR, and Max-Min HR in mild, moderate or severe nasal obstruction groups.

Discussion

The role of nasal obstruction in Obstructive Sleep Apnoea and the importance of HR as predictor of cardiovascular morbidity have been discussed. The studies on the heart rate in nasal obstruction and OSA were reviewed.

Conclusion

Nasal obstruction does not influence the heart rate.
Evaluation of Diagnostic Criteria for AFRS: A Hospital Based Study
Authors: Chaitanya Krishna V , Kalavathi Lakshmi C
Published: August 2020

Introduction

Bent and Kuhn criteria are the most commonly accepted diagnostic criteria for diagnosis of Allergic Fungal Rhinosinusitis. Other diagnostic criteria for the diagnosis of Allergic Fungal Rhinosinusitis include unilateral nasal disease, Charcot Leyden crystals, bony erosions which form the minor criteria in the diagnosis of Allergic Fungal Rhinosinusitis. Clinical and Laboratory features in Allergic fungal rhinosinusitis are variable. These variations in the diagnostic criteria in the diagnosis of Allergic Fungal Rhinosinusitis have been analysed in the present study.

Materials and Methods

Prospective study was performed on group of 46 patients of Allergic fungal Rhinosinusitis presenting in the Otorhinolaryngology OPD with symptoms of Allergic fungal rhinosinusitis as diagnosed and persisting for more than 3 months during September 2009 to August 2010.

Results

Absolute eosinophil count was elevated in 80.43%, total serum IgE elevated in 69.67%, skin prick test was positive in 63.05% of patients. CT scan revealed that most common paranasal sinus involved is ethmoid sinus as seen in 73.91% cases., Sphenoid sinus was least involved as seen in 17.40% cases. More than one paranasal sinus were involved in 65.21% of the cases.,Complete opacification of all sinuses with calcified deposits were seen in 4.76% cases. Mucosal thickening was seen bilaterally in 73.91% of the patients and bony erosion was noted in 6.52% of patients. Histopathology of nasal smears revealed Eosinophilia in 80.43% of patients. Inflammatory Charcot Leyden crystals were found in 15.21% of the patients45.65% showed goblet cell hyperplasia . Other types of inflammatory cells were seen in 56.52%of the study population and 23.91% patients showed positive fungal hyphae.

Discussion

The significance of absolute eosinophil count, skin prick test, histopathology, CT Scan features and nasal smear cytology have been discussed along with review of literature.

Conclusion

Although management of Allergic Fungal Rhinosinusitis has advanced tremendously with better understanding of underlying pathogenesis, diagnostic strategies are still far from clear and are still emerging. Lot of research work has to be carried out regarding relevant diagnostic criteria for the disease.
Comparison of Various Graft Materials in the Reconstruction of Ossicular Chain in Patients with Chronic Otitis Media: A Prospective Hospital Based Study
Authors: Fakhruddin Niaz , Gangaiah Chethan Kumar , KP Gopakumar , Thottan Geogin George , Noufal Mon
Published: August 2020

Introduction

Ossicular chain reconstruction is the surgical procedure used to correct the hearing problems in patients with chronic otitis media (COM). In this era, where a large variety of innovative artificial prosthetic materials are being used to replace and reconstruct the ossicular chain, autografts still play a significant role.

Materials and Methods

The present study included 40 patients. Study population was selected based on inclusion and exclusion criteria. The ossicular reconstructive procedure was done under anesthesia and according to the status of the ossicular chain. Temporalis fascia was used to close the perforation. Mainly two procedures were performed: one is intact canal wall and the other is canal wall down. 

Results

Most of the study population was middle aged and males were more compared to females. Thirty five patients had air bone gap above 30dB. In 38 patients, the incus had undergone necrosis. Most of the patients underwent short columella reconstruction. A closure of air bone gap with in 20 dB was achieved in 72.2% in patients with malleus stapes assembly. In short columella 22.2% of patients had closure of air bone gap within 20 dB. Incus remnant grafts gave better hearing gain.

Discussion

The published literature on the result of use of sculptured ossicle and cartilage in tympanoplasty have been reviewed

Conclusion

In the present study, cases with COM showed good hearing results patients implanted with autogenous cartilage and bone.
Role of Polidocanol as Sclerosant in Treatment of Hemangiomas of Head and Neck Region
Authors: Sangma Rupanjita , Patar Mukul
Published: August 2020

Introduction

Haemangiomas are common presentation in head and neck, prevalence being 60% followed by 25% and 15% respectively in trunk and limbs. This report studies the efficacy of Polidocanol as sclerosant in the treatment of heamangiomas in head and neck.

Materials and Methods

The two year prospective study conducted from January 2015 to December 2016 with Polidocanol as sclerosant on 55 patients attending the department of ENT. Intralesional injections of 3 % polidocanol were given at 2 week intervals.

Results

Out of 55 patients 15 cases did not follow up after the first dose, so results were calculated out of 40 patients. 12 patients showed complete regression & 15 showed regression to half the size. Thus 67.5 % patients showed acceptable results. There were no side effects except hyperpigmentation in 2 patients. There were no cases of recurrence during our study period.

Conclusion

Sclerotherapy is a promising method of treatment for haemangiomas of head and neck that may obviate the need for surgical intervention.
Midline Nasal Dermoid - A Series of Thirteen Cases and Review of Literature
Authors: Saha Vedula Padmini , Ghosh Debangshu , Dutta Santanu , Saha Somnath , Basu Sumit Kumar
Published: August 2020

Introduction

Congenital midline nasal masses include nasal dermoid sinus cysts, encephaloceles and gliomas. They are rare malformations, of which dermoid cyst is a relatively common congenital abnormality. A systematic review of the clinical feature and management outcome of congenital midline nasal dermoids would help in predicting the outcome of such cases.

Materials and Methods

A prospective observation was made on a series of patients with nasal dermoids with or without sinus tract for a period of three years. Altogether thirteen patients were evaluated. Age of the patients ranged from two to twenty seven years. There were seven males and six females. Intracranial extension was ruled out radiologically. Excision of the dermoid cyst with or without sinus tract was undertaken under general anesthesia and followed up for one year. 

Conclusion

Surgery is the gold standard treatment for nasal dermoids and complete excision and cosmetically good repair is mandatory for good results.
Congenital Midline Nasal Mass: Four Cases with Review of Literature
Authors: Chintale Sambhaji Govind , Jatale Sonali Prafull , Kirdak Vilas Rambhahu , Shaikh Kaleem Azeem
Published: August 2020

Introduction

Congenital midline nasal masses include nasal dermoids, gliomas, encephaloceles. Although rare, these disorders are clinically important because of their potential for connection to the central nervous system. Preoperative knowledge of an intracranial connection is a necessity to allow for neurosurgical consultation and possible planning for craniotomy. This study discusses the clinical presentation of congenital midline nasal mass and the role of imaging modalities like CT scan and MRI in diagnosis and the surgical management.

Materials and Methods

 This prospective study is carried from March 2014 to March 2016, during which 4 cases presented to the Otorhinolaryngology department. Pre-operative evaluation of the patients included endoscopic evaluation along with haematological investigations, CT Scan and MRI. The masses were removed with nasal endoscopic sinus surgery or by external approaches and neurosurgical intervention.

Result

The age of the patients ranged from 3 years to 25 years. Three of them were male and one female. There was one case of nasoethmoidal encephalocele and the other three were dermoids (intranasal dermoid cyst, nasal dermoid cyst and nasal dermoid sinus cyst).

Conclusion

Congenital midline nasal masses are rare. These disorders are clinically important because of their intracranial connection which require proper evaluation with radiological imaging like CT scan and/or MRI before FNAC and any surgical intervention.
Skull Base Langerhans Cell Histiocytosis with Diabetes Insipidus and Panhypopituitarism- A Rare Clinical Entity
Authors: Ghosh Anirban , Chaudhury Mithun , Mukherjee Abhishek
Published: August 2020

Introduction

A case of Langerhans cell histiocytosis (LGH) involving extensive area of base of skull resulting in panhypopituitarism and diabetes insipidus (DI) is reported.

Case Report

A 16 year old male presented with diminished vision, bilateral ptosis, left sided lateral rectus palsy, hypoesthesia of trigeminal nerve with nasal obstruction for last 5 months. There was polypoidal, bleeding mass in both nasal cavities. Contrast enhanced CT Scan showed a large homogenous mass arising from sphenoid extending into cavernous sinus and the suprasellar region. Endoscopic nasal biopsy revealed abundant Langerhans cell histiocytes, macrophages, neutrophils. Chemotherapy and radiotherapy were administered. But within 2 months the patient presented with Cushingoid features and further diminution of vision. Detailed work-up revealed Hypogonadotrophic hypogonadism and diabetes insipidus. Debulking of the tumour was done and left optic nerve decompression was done. PET scan was performed and showed large, well defined mass with increased FDG uptake in the skull base with suprasellar extension, reaching upto petrous temporal bone and causing bony erosion of ethmoid and sphenoid sinuses. Patient was then advised adjuvant chemotherapy.

 

Discussion

Langerhans cell histiocytosis is a rare group of disorders characterised by abnormal clonal proliferation and accumulation of abnormal dendritic cells. Involvement of base of skull is even rarer. Though diabetes insipidus has been reported in Langerhans cell histiocytosis involving pituitary, panhypopituitarism is rare. These combinations of extensive Langerhans cell histiocytosis of base skull with clinical features of Diabetes insipidus and panhypopituitarism makes this case a rare clinical entity.
Venous Malformation in the Neck
Authors: Adhikary Bijan Kumar , Kundu Sohag , Ghosh Bhaskar , Sinha Ramanuj
Published: August 2020

Introduction

Venous malformation is a benign vascular lesion. Approximately 40% of such cases occur in head and neck.

Case Report

Venous malformation in a 19 year old man is reported, which presented as a lateral neck swelling.

Discussion

The venous malformation in the head and neck region may confuse the surgeon in distinguishing it from its other common congeners e.g. hemangioma, lymphangioma etc. and may also cause dilemma regarding its treatment modality. Treatment options include surgery, laser therapy, sclerotherapy or a combination depending upon the complexity of the lesion.
How We Do It: A DIY Smart Phone based ENT Endoscopy
Authors: Duvvi Shyam , Neelapala P , Duvvi A S , Nirmal Kumar B
Published: August 2020

We present a simple method of preparing a smart phone based ENT endoscopy for OPD clinic and for on call ENT to provide emergency ENT care in Accident and Emergency department when required. In our experience, this method is efficient, economical and ensures mobility and flexibility of remote visual inspection and documentation. This aids in better care for patients especially where there is no easy access to traditional ENT treatment room facility. This provides a fast and cost-effective solution to simultaneously view capture and save photos and videos with a smartphone and, if required, send these pictures to oncall Consultant. This enables quicker identification, documentation and support regardless of location.
Do Socio-Economic Factors Play a Role in Delayed Presentation of Complicated Chronic Otitis Media (Squamous)?
Authors: Maggon Nidhi Vohra , Sethi Ashwani , RWR Harikesh , Pimparkar Surendra Vishwasrao
Published: August 2020

Introduction

The influence of Socioeconomic (SE) status on delayed reporting and consequent complications in cases of Chronic Otitis Media-squamous (COMS) has been investigated.

Materials and Methods

This prospective observational study included 34 patients with complicated COMS who presented to Otolaryngology Department at a tertiary care teaching hospital between December 2012 and December 2016. The patients were classified into 5 classes namely upper, upper middle, lower middle, upper lower, and lower based on a standardised real-time Kuppuswamy’s SE status scale (KS) taking an average of consumer price indices for Industrial workers over 4 years (Jan ‘12 to Dec ‘16) as 267 and calculating their incomes. Level of education and occupation of the head of the family were the other components of KS which was calculated for each presenting patient.

Results

Of the 34 patients, 15 were males (44%) and 19 females (56%) with their ages ranging from 18 months to 61 years (Mean-24.1 years, SD-17.3). 15 of the 34 patients (44.1%) were in the Upper-lower SE class as per KS Scale, 13 were in lower-middle class (38.23%), 5 were in Upper-middle class ( 14.70%) and 1 patient belonged to Upper class (2.9%).  Though the literacy levels are integral to KS Scale a differential analysis showed 23 of the 34 patients/guardians had education level poorer or equal to Intermediate high school (67.64%). The time gap between onset of symptoms of COMS and presentation with complications of COMS ranged from 9 months to 8 years with a mean time gap of 3.48 years (SD-2.01). There were 24 Extra-cranial complications and 21 Intra-cranial complications with 10 patients having more than one complications. There was a strong inverse correlation between Time gap and composite KS (-0.51). A differential analysis showed that Time gap most strongly correlated with Education level of the head of the family (-0.615), followed by total family income (-0.403) and occupation of the head of the family (-0.329).

 Conclusion

There is a strong association between the SE status of the family and the occurrence of complications in COMS that is otherwise highly amenable to successful management. Level of education, nature of employment and family income that constitute KS scale have significant inverse correlation with delayed reporting and consequent complications of COMS. Level of Education is the greatest influence on the time gap.
Juvenile Nasopharyngeal Angiofibroma: Changing Paradigms in Management
Authors: Bhalla Vijay , Narayanaswamy Ramakrishnan
Published: August 2020

Introduction

Juvenile Nasopharyngeal Angiofibroma (JNA) is a tumor of young and adolescent males. It is a benign vascular tumor arising from the spheno-palatine foramen. It is best managed surgically at present by endoscopic methods with or without pre-operative embolization. Tumor attributes like intracranial extent and residual vascularity after embolization need to be assessed pre-operatively before undertaking endoscopic surgery, in order to reduce surgical blood loss and morbidity.

Materials and Methods

Twenty-three cases of JNA (n=23) were operated endoscopically at a tertiary level military hospital. They were staged with the Snyderman staging system. Demographic variables including stage wise management were brought out with intraoperative time and blood loss recorded for different stages.

Results                                               

The intraoperative surgical time, intra-operative blood loss and recurrence/residual rates were compared with similar studies in existing literature and correlated well.

Conclusion

Endoscopic Endonasal approach to JNA is now a well-established technique. With improvements in embolization techniques and better instrumentation like HD camera systems, endo-bipolar cautery, Coblation and endo-liga clips and neuro-navigation, better visualization and better haemostatis can be achieved, resulting in significant reduction in the morbidity and improvement in surgical results.