Effect of tonsillectomy on humoral immunity.

Tonsils are one of the important secondary lymphoid organ in immune system. It remains controversial whether tonsillectomy results in decreased serum immunoglobulin level. The purpose of this study was to observe the effect of tonsillectomy on humoral immunity parameters among the patients with tonsillar disease. Total group A 70 patients up to the age of 18 years, who were enrolled for tonsillectomy and 30 age matched children group B were included for comparative study. Serum IgG, IgM and IgA levels were measured in all 70 patients before tonsillectomy and in 56 patients who came for 1st follow-up after one month and 30 patients who came for 2nd follow up after three months of tonsillectomy. Serum IgG, IgM and IgA levels were also measured in group B children. Serum IgG, IgM and IgA levels in patients of group A did not show any significant difference in comparison to group B. One month after tonsillectomy the level of IgG was slightly decreased and IgM and IgA were increased compared to preoperative value but not statistically significant. All IgG, IgM and IgA were also not significantly altered in comparison to group B. Three months after tonsillectomy serum IgG, IgM and IgA level were found decreased in comparison to pre operative value and group B, among which difference of only IgG was significant. After tonsillectomy humoral parameters were found reduced but overall impact on humoral immune status was not significantly altered.

Tubercular lymphadenitis - diagnostic evaluation.

Tuberculosis is one the commonest disease affecting peripheral lymph node and cervical tubercular lymphadenitis are frequently encountered in Otolaryngological practice. Three hundred fifty six (356) cases of Fine Needle Aspiration for Cytology (FNAC) positive tubercular lymphadenitis were studied from January 2006 to December 2008. FNAC positive but histopathologically negative cases were excluded from the study. Among 356 cases of FNAC positive cervical lymphadenopathy 300 cases (84.27%) were confirmed tuberculosis on histopathological examination. Remaining 50 cases (15.73%) were diagnosed as nontubercular lymphadenitis where nonspecific lymphadenitis was the commonest finding 34(9.55%) followed by metastatic carcinoma 7(1.97%), lymphoma 6(1.08%), Kikuchiz's disease 6(1.08%), Kala-Azar 2(0.56%) & Leukemia 1(0.28%). Most of the patients presented with only multiple lymph node swelling with other symptoms, such as fever 18(5.06%), pain (15.7%), tenderness 53(14.88%), weight loss 29(8.14%), anorexia 33(9.26%). Following observations are evident from this study: i) Disease is comparatively common between 12-35 years ii) Multiple matted/discrete lymph nodes are the earliest presentation iii) Multiple lymph node is the most consistent finding for clinical diagnosis. iv) Very few patients have constitutional symptoms v) Suppuration with or without abscess formation although confirms the diagnosis even then certainty is very essential. Though the evidence of cervical tuberculosis was thought to be decreasing in developing countries the real picture seems to be different. Random survey among the whole population was not done in any country rather hospital based laboratory research was made.

Endoscopic dacryocystorhinostomy.

Dacryocystorhinostomy (DCR) is the treatment of distal nasolacrimal duct blockage. It has got many advantages of over external DCR with higher patient's acceptance. Twenty one consecutive cases of endoscopic DCR were studied during the period of two and a half years with a mean follow up period of 13.12 months (SD=7.05). The mean age of cases was 42.95 years (SD=14.49). In most of the cases the cause was either idiopathic (71.43%) or inflammatory (23.81%). The techniques used for making bony window were chisel-hammer (19.50%), powered drill (23.81%), Kerrison punch forceps (14.29%) or combination of powered drill and Kerrison punch forceps (42.86%). Silicon stent was used in 71.43% cases. There was no significant peroperative complication; premature extrusion of stent (4.76%), synaechia (9.52%), excessive granulation tissue formation (9.52%) and stomal stenosis with recurrence of symptoms (9.52%) were the complications noticed here. Anatomical success with patent stoma was observed in 90.48% cases but symptomatic improvement with dry comfortable eyes were seen in 86% cases. There was no statistically significant difference of outcome between this study and that of recently published studies (p>0.05). Some comparative studies showed both higher and lower success rates of endoscopic DCR than external procedure but there was no significant difference (p>0.05).