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Subglottic stenosis is narrowing of the area in between the vocal cords and the cricoid cartilage. It can cause respiratory problems which can be mild to severe. Study the management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis. Case Setting and Design: Retrospective study of 18 patients presenting with encephalitis out of which 6 cases were of post-intubation subglottic stenosis associated with Japanese encephalitis between the study period of one year (September 2017-September 2018) in the, Department of Otolaryngology and Head and Neck Surgery, North Eastern Indira Gandhi Regional Institute Of Health And Medical Sciences, Shillong, Meghalaya, India. Fifteen patients were treated in the study period. Different approaches were used. Post-intubation subglottic stenosis depends on the duration of intubation and the quality of life post-tracheostomy depends on the type of tube used. Bronchoscopic assisted procedures during the tracheostomy or after an interval helps to decrease the morbidity. Management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis needs proper strategy and dedicated and intensive post-operative care. Bivona® silicone tracheostomy tube is a better option.
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Suvamoy ChakrabortyIntroduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017-2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively ( p -value < 0.001, Fischer's exact test). Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.
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Branchial cleft cyst in parapharyngeal space is a very rare occurrence. Only 0.5% of all head and neck tumours constitute parapharyngeal space tumours. It is mainly congenital but can be seen at a later age following infection. MRI is the gold standard for diagnosis. This is a case report of a 19-year-old with right sided neck swelling without any significant history. It has been excised by transcervical approach.
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Acute parotitis in children is a common occurrence with predisposing factors including ductal dysfunction, poor oral hygiene or dental infections, immunosuppression, dehydration, or a pre-existing Warthin's tumour. Bacterial or viral infections of the intra-parotid and peri-parotid lymph nodes or the parotid gland parenchyma results in inflammatory followed by suppurative changes which leads to formation of parotid abscess. Surgical drainage is necessary in parotid abscesses not responding to conservative management. Surgical intervention is invasive and has associated risks of injury to the facial nerve and poor cosmetic outcome. We present a case of parotid abscess in a 9-year-old female child which required surgical drainage. In literature, parotid gland abscess arising from a preceeding dental infection in paediatric age group is an uncommon occurence and limited number of cases have been documented. The first line of imaging is ultrasonographic examination of the parotid gland which adds on to the clinical examination. In combination with color doppler, sonography is of immense assistance for diagnosis and evaluation of therapeutic efficacy and also helps guide aspiration or incision and drainage.
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Kimura Disease, an eosinophilic hyperplastic granulomatous disease of idiopathic origin is most commonly seen in young males. It mostly presents with deep subcutaneous tissue swelling along with enlargement of salivary glands and regional lymphadenopathy. Diagnosis is mainly based on histopathological findings and raised serum IgE and hypereosinophilia. The radiological investigation of choice is Magnetic Resonance Imaging. Management strategy includes surgery and steroid therapy. Chemotherapeutic agents are also frequently used by some centres. Relapse and recurrence stands to be a common problem with management of this disease process. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03817-y.
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Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls.
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INTRODUCTION: Iron plays an important role in myelination. Ferritin is a reliable indicator of the tissue iron store and umbilical cord ferritin level reflects the in utero iron stores. Objective is to study the effect of the umbilical cord ferritin level on the ABR recording in the newborn. MATERIALS AND METHODS: The study was conducted in a tertiary care hospital in India with a sample of 250. The study group was divided into Group A (with umbilical cord ferritin level of ≤ 75ng/ml) and Group B (umbilical cord ferritin level > 75ng/ml). Correlation analysis was carried out to study the relation between ferritin level and latency of wave I,III and V. Two sample t test was done between the two groups to study the significance of latency and amplitude of various ABR waves. RESULTS: There was no correlation between the ferritin and ABR threshold as well as latency and amplitude of ABR waves. A significant prolongation of the absolute latency of wave V and the interwave latency of III - V and I -V of both the ears was found in Group A. The amplitude of the ABR waves did not show any statistical difference between the two groups. CONCLUSION: Ferritin levels effect the latency of wave V of ABR and this may be attributed to slow conduction time secondary to altered myelination. Measurement of serum ferritin may be considered as a routine protocol in newborn babies after delivery or before discharge from hospital.
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Grisel's syndrome is non traumatic atlanto axial subluxation usually associated with inflammatory conditions of head and neck region. Non traumatic atlanto axial joint subluxation is a rare entity for an unsuspecting otolaryngologist. The condition if missed and not treated properly can have serious implications with possible neurological deficit. We attempt to review the existing literature on the disease condition and also to highlight the proper management of the condition. Retrospective analysis of hospital record of last five years and an internet based literature survey on the current concepts and management of the condition. We have come across five cases of Grisel's syndrome over the last five years. The clinicopathological and radiological features are described. Grisel syndrome may remain undiagnosed at initial presentation if not suspected. Delayed diagnosis may result in life long morbidity for the patient and the need for surgical intervention. Many of the early cases can be treated successfully by conservative approach.
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Dizziness is a common symptom and though most of the causes are benign yet some may be potentially life threatening. Diagnosis can be a challenge sometimes due to lack of dedicated vestibular lab and injudicious use of vestibular suppressant medications. A 2 year retrospective study of the hospital records from September 2014 to August 2016 was done to study the causes of dizziness and the limitations and challenges in the diagnosis. 75 complete records of patients presenting with dizziness were accessed and analysed. 54.7% of the patients were males and most patients were young adults. Most of the cases were benign and Benign paroxysmal positional vertigo was the commonest diagnosed case (20%). Potentially life threatening cases diagnosed were cerebellar infarct and posterior fossa space occupying lesion (5.3%). Complete evaluation of a dizzy patient must be done to arrive at a causal diagnosis. Injudicious use of vestibular sedatives should be discouraged. Proper training and education to the primary care physician should be imparted so that they can adopt a practical approach for evaluation and management of a dizzy person.
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Chronic Sinusitis, an extremely persistent illness, is surgically best treated by Functional Endoscopic Sinus Surgery. The ostiomeatal complex is the main area targeted and within it uncinate process is the first anatomical structure encountered. The significance of anatomical variations concerning age and sex of uncinate process in chronic sinusitis were evaluated. A prospective study on 50 patients of chronic sinusitis (100 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science (SPSS) 16.0. Type I superior attachment of uncinate process (67 %) was the most common variety in all ages and both sexes and a statistically significant relationship between Type I superior attachment of uncinate process and sex was found (p < 0.05). The typical uncinate process was most common (70 %) followed by medial deviation of the uncinate (24 %). This difference in occurrence was significant with respect to both age and sex (p < 0.05). Anatomical variations of uncinate process are not responsible for causing chronic sinusitis. Mere presence of these variations of uncinate is not an indication for FESS.
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Mucoceles are accumulations of trapped mucus, forming cystic expansile lesions. Maxillary sinus mucoceles are rare amongst paranasal sinus mucoceles, usually being a late sequel of Caldwell-Luc surgery. We present a case of a maxillary sinus mucocele due to a persistent carious deciduous molar in a middle aged patient, reported to highlight its unusual etiology.
