Role of Histopathology in Differentiating Primary Atrophic Rhinitis from Atrophic Stage of Rhinoscleroma.

Atrophic rhinitis (AR) is a chronic debilitating nasal mucosal disease of unknown aetiology and the definitive treatment is still elusive. This often leads to the patient suffering during the entire life span often depleting the individual psychologically. On the contrary, Rhinoscleroma (RS) for which the aetiology is clearly known and is completely curable has atrophic stage which is clinically indistinguishable from AR. Many cases of atrophic stage of RS are undetected and often they end up being treated as AR. This study was conducted to know the role of histopathology and other factors in differentiating AR and Atrophic stage of RS, which can significantly alter the course of treatment and outcome. Forty-five cases of clinically diagnosed AR were included in the study. Punch biopsy of nasal mucosa was obtained from the anterior end of inferior turbinate. Core culture was performed on one sample and histopathological examination for the other sample. Among the 45 patients, 38 (84.44%) of cases were diagnosed to be AR and 7 (15.56%) cases were diagnosed to be RS by histopathology. Core culture of RS subjects showed positive culture for Klebsiella rhinoscleromatis in five subjects (71%). To conclude, AR cases should be confirmed by histopathological examination to rule out RS, for effective management and to prevent complications.

Recent Trends in the Management of Thornwaldts cyst: A Case Report.

Tornwaldt's cyst is a benign cyst located in the upper posterior nasopharynx. It is a relatively rare lesion and most are small and asymptomatic whereas some cause nasal obstruction, postnasal drip, occipital headache or eustachian tube dysfunction. In our case a 28- year-old man presented with nasal obstruction since 10-years whose diagnostic nasal endoscopy showed a large well-encapsulated lesion arising from the posterior wall of the nasopharynx. A magnetic resonance imaging (MRI) was performed which was suggestive of a fluid filled cystic lesion. The patient underwent successful marsupialisation using endonasal endoscopic approach using rigid endoscopes and powered instrumentation. Histopathology of the aspirate revealed a respiratory lined epithelial cyst. Based on the clinical, radiological and histopathological findings a diagnosis of Tornwaldt's cyst was made. We report this case to highlight the role of MRI in diagnosis and use of endoscopic assisted powered instrumentation for treatment of Tornwaldt's cyst.

Complications in primary and secondary acquired cholesteatoma: a prospective comparative study of 62 ears.

OBJECTIVES: This study aimed to compare the clinicopathologic behavior of complications in primary and secondary acquired cholesteatoma and figure out the differences between them. DESIGN: This was a prospective cross-sectional study. METHODS: This was a study conducted in a tertiary referral medical college hospital comprising of 62 ears, of which 32 were in the primary acquired cholesteatoma group (PACG) and 30 were in the secondary acquired cholesteatoma group (SACG). We compared the 2 groups with respect to 7 prognostic variables, as follows: age distribution, sex, duration of ear discharge, pathology in the ear, predisposing disease focus in nose and throat, pattern of complications, and microbiology of ear. OBSERVATION AND RESULTS: The presence of cholesteatoma increased the risk for complications by more than 2 times in PACG, but the presence of granulation tissue did not show the same risk. More than half of the ears with complication contained some or the other predisposing disease focus in the nose or throat. The PACG was 3 times more prone to complications than the SACG in the presence of these foci. They showed a similar pattern of complications. Brain abscess and mastoid infections were the commonest complications. CONCLUSIONS: The PACG was more prone to complications than the SACG in the presence of cholesteatoma and focus in the nose and throat. Irrespective of the different pathologic origin of the 2 types, the patterns of complications remained the same with no major differences, indicating a common final pathway in the natural course of the disease.

Cerebrospinal fluid otorrhea presenting in complicated chronic suppurative otitis media.

Since the introduction of antibiotics, the simultaneous occurrence of multiple intra- and extracranial complications in chronic suppurative otitis media (CSOM) has been uncommon. Such a combination is associated with high mortality and morbidity, especially in the pediatric age group. Cerebrospinal fluid (CSF) otorrhea presenting in CSOM is unusual and rare. To the best of our knowledge, only 19 cases of CSF otorrhea in complicated CSOM have been previously reported in the literature. Identifying the site of leak might require a high index of suspicion. Management of such a case could be challenging in terms of leak closure, disease clearance, and restoration of function. We report a new case of CSF leak in CSOM, and we describe our line of management. Even though CSOM is an uncommon indication for radical mastoidectomy today, such surgery might be necessary for these cases.