ABSTRACT
Epistaxis is one of the common otorhinolaryngological emergencies that are encountered in daily practice. Aetiology of epistaxis may range from benign conditions like septal spur, infected nasal polyps etc to serious causes like malignancies. Many a times, the cause for epistaxis is not found on anterior and posterior rhinoscopy. We wanted to assess the role of nasal endoscopy and computed tomography of paranasal sinuses (CT scan of PNS) among patients with epistaxis in whom the cause is not evident after history taking and clinical examination. MethodsThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. For patients included in the study, diagnostic nasal endoscopy under local anaesthesia was done and findings were noted. If any bleeding point was visualised on endoscopy, it was cauterised. In selected cases, endoscopic biopsy from nasal mass was done, and sent for histopathological examination. CT scan of PNS was done and findings were noted. ResultsIn the evaluation of patients with epistaxis of inapparent aetiology, nasal endoscopy could aid the diagnosis in 61.8% of patients, and CT scan of PNS in 81.8 % of patients. Statistical comparison of measure of agreement between nasal endoscopy and CT scan of PNS for diagnosis of epistaxis of clinically inapparent aetiology yielded a kappa value of 0.187 which can be interpreted as slight agreement. Sensitivity of nasal endoscopy and CT scan for diagnosing sinonasal neoplasms as compared to histopathological examination (gold standard) was 83.3% and 100% respectively. Both had an accuracy of 66.7% as compared to histopathological examination. Statistical comparison of measure of agreement between nasal endoscopy and CT PNS for diagnosing sinonasal inflammation yielded a kappa value of 0.391 which can be interpreted as fair agreement. ConclusionsFor evaluation of sinonasal neoplasm causing epistaxis, CT scan of PNS has higher sensitivity than nasal endoscopy. Subclinical sinonasal infection could be a triggering factor for epistaxis in older patients. Nasal endoscopy and CT scan of paranasal sinuses are important and complementary tools in the evaluation of epistaxis.
ABSTRACT
Hoarseness is defined as the perceived rough, harsh or breathy quality of voice. Since both benign and malignant lesions can produce hoarseness, timely evaluation is very important because delay in the diagnosis of malignancy can adversely affect the outcome. We wanted to study the treatment and its outcome in patients with hoarseness of various aetiologies, and compare the response to treatment between various groups.METHODSThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. In patients with hoarseness, history was elicited, clinical examination was done, and perceptual evaluation of voice was made using GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. Direct laryngoscopy and biopsy were done whenever suspicious lesions were seen. Early laryngeal cancer was treated with radiotherapy, while advanced cases were treated with chemoradiation. Other cases were treated with medications, Video Laryngeal Surgery (VLS) or voice therapy, according to the diagnosis. Patients were kept under follow up; reassessment was done after six months regarding improvement/ persistence/ deterioration of previous symptoms. Laryngoscopy and perceptual evaluation of voice were repeated, and the data collected was analysed.RESULTSOn treatment, the lesion subsided completely, and hoarseness got relieved in all the cases of laryngitis, trauma, vocal nodule, vocal polyp and cyst, while the lesion subsided partially, and hoarseness improved in vocal cord palsy, papilloma and carcinoma of glottis. The response to treatment was better in benign lesions when compared to malignant lesions (P value < 0.0001) and better in glottic malignancies when compared to malignancies at other nearby sites (P value <0.001).CONCLUSIONSMost of the benign conditions that caused hoarseness subsided and voice became normal with medications, video laryngeal surgery and voice therapy, while hoarseness persisted to some extent after treatment with radiotherapy or chemoradiation in most of the patients with malignancy.