Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress.

Difficult airway is a commonly encountered problem in the anesthesia practice, might needing otolaryngologist expert in creation of surgical airway. Supraglottic airways, surgical or needle cricothyrotomy, high frequency jet ventilation, cardiopulmonary bypass (Tunstall in Can J Anaesth 36:611-613, 1989) are initial rescue measures in such scenario. But in otolaryngology practice, patient presenting with stridor having difficult airway and difficult tracheostomy concurrently will definitely pose problems resulting in life-threatening consequences. We report cases in which difficult airway and difficult tracheostomy coexisted. (1) upper tracheal stenosis following strangulation and intubation (2) short neck with obesity (3) blunt trauma to neck with surgical emphysema (4) deep neck space infection (5) Paediatric tracheostomy in faucial diphtheria. Though difficult surgical tracheostomy in difficult airway is challenging, the anticipation of complications and planning can minimise the difficulty in the technique.

Improving the Results of Endonasal Dacryocystorhinostomy with Mitomycin C Application: A Prospective Case-Control Study.

Many surgical advancement paved to surgical success in endonasal endoscopic dacryocystorhinostomy. Mitomycin C is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. The objective of the study was to evaluate the advantage of mitomycin C in primary endoscopic endonasal dacryocystorhinostomy without stenting. Randomised case control design. Tertiary academic centre in central India. 112 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups with or without mitomycin C intraoperative application. 112 eyes underwent endoscopic-dacryocystorhinostomy. Additional surgeries were done according to necessity. Mitomycin C was applied in concentration of 0.4 mg/dl for 5 min. Patients were followed up on OPD-basis at the end of 1st week, 1st month, 3rd month and over phone call at end of 1 year. Symptomatic improvement assessed by verbal enquiry and clinically by syringing by ophthalmologist. 8 patients underwent septal surgery in case group and 4 in control group along with 1 concha bullosa correction in the case group (p < 0.05). Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96.5% at 3rd month in case group and 96.4% and 92.9% at 1 month and 3 month respectively in control group. Nasal endoscopy of all surgical failures showed restenosis in both case group and control group except 1 patient with granulation in control group. Eventhough intraoperative mitomycin C application is effective in increasing the success rate of endonasal DCR surgery in standard nasolacrimal duct obstruction, and with no significant complications from its use, the study did not show added benefit in the primary endoscopic endoscopic dacryocystorhinostomy without stenting.

Manoeuvres to Improve Endoscopic Visualization of Hypopharynx.

The more progress achieved in endoscopy, the more superficial cancers in head and neck region have been diagnosed. There are, however, some areas difficult to observe, particularly the hypopharynx, due to closure of this space. Examination of hypopharynx form an essential part of head and neck examination especially in the suspected malignancies as well as in the cases with unknown primary. As the flexible fiber-optic nasopharyngolaryngoscopy forms an essential part of examination of hypopharynx, the present study aims to evaluate the effectiveness of various manoeuvres devised to aid in better visualization of the hypopharynx. The present prospective study is an observation carried out on 30 patients, which had been followed up for hypopharyngeal or laryngeal disease, in the OPD of the department of Otorhinolaryngology and head and neck surgery in Gandhi Medical College and associated hospital, Bhopal, M.P. In the present study, authors compared the visibility of subsites of hypopharynx in 30 patients undergoing trans nasal flexible fibre optic endoscopy in normal seated position and with head torsion, valsalva manoeuvre and the Killian position. The authors concluded that the above mentioned manoeuvres facilitated the visualization of the entire circumference of the hypopharynx during endoscopic examination, are non invasive and easy to perform and so should be included as a part of routine examination while performing flexible fibre optic endoscopy.

Changing Trends of HIV/AIDS in Otorhinolaryngology with CD4 (+) Count Correlation.

Human immunodeficiency virus (HIV) affects the vital cells of the immune system eventually leading to a fall in the cell mediated immunity. As the disease progresses CD4 (+) (cluster of differentiation4) cells reduce, therefore is a good indicator of the ongoing disease process [1]. HIV infection has myriads of disease presentation; the aim of our study was to correlate the otorhinolaryngological manifestations with the CD4 (+) counts. A clinical study, of 100 HIV positive patients was done from 2008 to 2011. A clinical evaluation revealed 76 % incidence of otorhinolaryngological findings. Oropharyngeal manifestations were the commonest, seen in 48 %, predominantly oropharyngeal candidiasis. Neck nodes were found in 20 % of the patients. 31 % had otological manifestations of which retracted tympanic membrane (eustachian tube dysfunction) was the commonest. 18 % had nasal symptoms of which rhinosinusitis was the commonest being 14 %. The mean CD4 (+) count was below 200 in patients who presented with oropharyngeal candidiasis, otitis externa and epistaxis. With the use and availability of HAART (Highly active antiretroviral therapy) more and more patients with higher CD4 (+) count are presenting with a different spectrum of more subtle disease manifestations, with lower incidence of the classical diseases like candidiasis. A routine otorhinolaryngological evaluation at every visit with high index of suspicion can help in better disease control and give a better quality of life.

Incidence of foreign bodies in aerodigestive tract in vindhya region: our experience.

Foreign bodies in aerodigestive tract are frequent occurrence and may lead to life threatening situation due to obstruction caused in respiratory passages. To present foreign body ingestion cases observed in a 5-year period at the S.S. Medical College and G.M. Hospital, Rewa (MP). The present study is a retrospective analysis including 108 patients of foreign bodies of aerodigestive tract of Vindhya region who presented to the S.S. Medical College and G.M. Hospital, Rewa from January 2008 to August 2012. About 92 patients of total 108 patients had evidence of foreign body in food passage with age ranging from 9 month to 85 years. Most patients 65 (70.65 %) belong to <10 year age group. Radiological evidence was found in 76 (82.6 %) patients. Most common foreign body was found to be coin 75 (81.52 %). The commonest site of lodgement was cricopharynx. About 16 patients of total 108 patients had evidence of foreign body in airway with age ranging from 9 months to 72 years. Most cases 8 (50 %) belong to <10 year age. Maximum cases showed vegetative foreign body with right bronchus (58.33 %) as commonest site of lodgement. Early detection by meticulous history, imaging modality and prompt management remains basis for favourable outcome and prevents future complications.

Accuracy of fine needle aspiration cytology in head and neck masses.

In ENT clinical practice patients with neck swelling is a common presentation. To know their exact nature a simple, sensitive and diagnostic tool is required to prevent unnecessary costlier investigation and corresponding treatment. Fine needle aspiration cytology (FNAC) is a very safe, sensitive and diagnostic tool. This study was done to know the diagnostic accuracy, sensitivity and specificity of the FNAC in head and neck masses. Present prospective study was done in 179 patients of head and neck masses which were subjected to FNAC and their results were later correlated with histopathological examination report (HPR) wherever available. Out of 179 FNAC, HPR available only in 152 cases. In present study 104 cases (58.10 %) of lymph node, 35 cases (19.55 %) of thyroid gland, 17 cases (9.49 %) of salivary gland, 12 cases (6.70 %) of soft tissue and 11 cases (6.14 %) of miscellaneous swellings were present. The sensitivity, specificity, positive predictive value and negative predictive value of present study were 81.8, 95.0, 81.8 and 95.0 % respectively. The accuracy was 92.10 %.

Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases.

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40 years (50.74 %) with male preponderance (55.22 %), chief symptoms being nasal obstruction (86.56 %), headache (73.13 %) and nasal discharge (52.23 %). Left sided DNS is more common (64.17 %). Most of the patients have moderate DNS, i.e. 6°-10° (56.7 %), followed by severe (22.4 %) and then mild (20.9 %). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13 %). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p < 0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.

Thyroglossal Duct Cyst, Variation in Presentation, Our Experience.

Thyroglossal duct cysts are most common midline congenital swelling in head and neck region. It results from incomplete involution of thyroglossal duct. They present as midline painless swelling in neck. We have studied variation in their presentation. The retrospective study carried out in department of ENT in Gandhi Medical College Bhopal from Jan 2009 to Sept 2013. Objective of this study is, to study incidence of Thyroglossal Duct Cyst in different age and sex group and variation in presentation. Clinical records, medical records and histopathological records were studied. 10 patients diagnosed as Thyroglossal Duct Cyst included in study. 10 patients were found to be diagnosed as Thyroglossal Duct Cyst. Out of 10 pt. 6 were pediatric patients and 4 were adults. 8 patients presented with cyst while 2 presented with fistula. Out of 10 patients 3 presented with suprahyoid, 2 at the level of hyoid and 5 had infrahyoid presentation. 7 patients undergone sistrunk operation procedure while 3 undergone simple excision. Out of 3 patients who undergone simple excision 1 patient develop recurrence. Thyroglossal Duct Cyst are one of the most common asymptomatic midline neck swelling and should be differentiated with other swellings with proper investigations.

Sinonasal masses: a retrospective analysis.

To study clinico-pathological profile of sinonasal masses (SNM). This is a retrospective analytical review of 92 patients of SNM who presented to Department of ENT, S.S. Medical college & Associated Hospital, Rewa from January 2008 to August 2012. Their biodata, clinical profile and histolopathological diagnosis were analyzed. The study design was retrospective done in tertiary referral hospital setting. In the present study total 92 patients with age ranging from 7 to >70 years were analysed. The overall M:F ratio was 1.35:1. Most of the patients (35.86 %) belong to 11-20 year age group. The main presenting symptoms were nasal blockage (94 %) and rhinorrhoea (90 %). About 48.9 % cases showed mass on left side, 34.78 % on right side and 16.3 % bilateral. Maximum cases 42.39 % were reported to be antrochoanal polyp followed by ethmoidal polyp and angiomatous polyp. About 6.52 % cases were histopathologically reported to be malignant. This article gives an insight into prevalence of SNM in this region of North India thus advocating early recognition, proper diagnosis and treatment of SNM.

Foreign body oesophagus in neonate with unusual presentation.

Children up to the age of 6 years present commonly in the ENT Department with the foreign bodies in the aero-digestive tract. The most common foreign body is coin in the cricopharynx. But it is rare to see foreign body in neonate. Authors have come across with a rare case of foreign body oesophagus in neonate causing obstructive symptoms to both respiratory and food passages after homicidal attempt.

Encephalocoele as a complication of intranasal surgery.

Intranasal encephalocoele can be congenital or acquired as a consequence of injury to the floor of anterior cranial fossa disrupting dura resulting in herniation of brain tissue in the nasal cavity. Authors came across a case of encephalocoele as a complication of intranasal polypectoury. We are reporting this case due to its rareness.

Unusual foreign body (broken tracheostomy tube) in left main bronchus.

Foreign bodies in the tracheobroncial tree are commonly seen in children and less so in adults. All manners of materials have been described as accidentally entering the tracheobroncial tree. Although tracheostomy tube as a foreign body in tracheobroncial tree is not so common, it is still well known. They present as emergencies and require skillful management. Few cases of tracheotomy tube in the tracheobrochial tree. have been reported in the literature till date. We have some across such case of broken fuller's tracheostomy tube (flange) in left main broncus and mwe are reporting this casedue to its rarity.

Study of Auditory function in Rheumatoid Arthritis.

Rheumatoid Arthritis may affect the auditory function and is a subject of debate. The exact etiopathogenesis is not known. However there is evidence of rt of synovial joints of ossicles. Rheumatoid Arthritis may involve the Aoditory system by producing conductive hearing loss, abnormal otoadmittance and sensorineural hearing loss. Patients with pre-existing ear disease were not included in the study. In the present study, effcet of Rheumatoid Arthritis on auditory function is observed. The Study was carried out on 25 patients of classical or definite Rheumatoid Arthritis and 16 controls at M.Y. Hospital, Indore.

Study of bacterial flora in csom and its clinical significance.

Middle ear infection of varying degree is one of the common condition in general practice, particularly in our country. Its importance lies in its chronicity and its dreaded complications. Chronic suppurative Otitis media (CSOM) and its complications are among the most common conditions seen by the otologist, pediatrician and the general practitioner. Both gram positive and negative organisms are responsible for infection of the middle ear.The study was primarily carried out in 100 cases of C.S.O.M. to determine the bacterial flora and to study the antibiotic sensitivity pattern of the organisms isolated. The frequent presence of C.S.O.M. and its poor response to the routine treatment were the factors which were responsible for undertaking this study.

Retropharyngeal abscess following accidental throttling.

Acute retropharyngeal abscess is common in infants and small children due to supuration of retropharyngeal lymph nodes. It is also not uncommon in adults due to injury of posterior pharyngeal wall by sharp object, foreign bodies and instrumentation. But acute retropharyngeal abscess following accidental throttling is reported for unusual etiology.In present study a case of accidental throttling followed by acute retropharyngeal abscess is being reported due to rareness.