Obstructive Sleep Apnoea Syndrome and Association of AHI Scores with Sensorineural Hearing Loss: An Early Predictor.

Obstructive sleep apnoea syndrome (OSAS) is a condition that is characterised by frequent apnoea and hypopnoea attacks occurring during sleep. The blood supply to cochlea and acoustic nerves is from terminal arteries, thereby making them susceptible to hypoxia. To compare the audiological profiles in patients with OSAS according to Apnoea Hypopnoea index (AHI) score. Descriptive study was conducted in 32 patients diagnosed to have OSAS in a tertiary referral centre over two year period. The study group was divided into mild, moderate, severe OSAS based on AHI score. The hearing evaluation was done using pure tone audiogram (PTA) and distortion product otoacoustic emission test (DPOAE). Moderate and severe OSAS participants had elevated thresholds at higher frequencies in PTA (4 kHz, 8 kHz), although this was not statistically significant. We also noticed, absent DPOAE responses at higher frequencies (4 k, 6 k, 8 k), with increase in the severity of OSAS at higher frequency, which was statistically significant (p value < 0.05). This study revealed elevated hearing thresholds at higher frequencies (4 kHz, 8 kHz) in PTA and DPOEA with an increase in the severity of OSAS. All OSAS patients, especially with AHI > 30 should be regularly screened for hearing loss.

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers.

OBJECTIVE: This study evaluated the effect of voice intervention in patients who received chemoradiation to the neck for non-laryngeal head and neck malignancies. METHODS: Twenty individuals with non-laryngeal malignancies of the head and neck who received chemoradiation were divided by block randomisation into an intervention group that received voice rehabilitation and a control group without rehabilitation. All patients underwent acoustic analysis, perceptual and subjective analysis of voice before the commencement of chemoradiotherapy and at 1, 3 and 6 months after chemoradiotherapy. RESULTS: In both groups, all parameters were significantly altered at one month follow-up except for fundamental frequency (females in control group and males in intervention group). In the intervention group, all parameters returned to pretreatment levels (no statistical differences) at 6 months. In the control group, all except for a few subjective parameters (grade, breathiness and asthenia) remained significantly altered at 6 months compared to the levels before radiotherapy. CONCLUSIONS: In non-laryngeal head and neck malignancies, voice rehabilitation offered at 1 month after treatment ameliorates chemoradiation-induced dysphonia within 6 months.

Adenoid cystic carcinoma of the parotid gland associated with salivary calculi: An unusual presentation.

Adenoid cystic carcinomas (ACC) of the head and neck are relatively rare tumors, consisting of approximately 10-15% of all salivary gland neoplasms. ACC, a slow-growing aggressive malignant tumor of salivary gland commonly seen in the submandibular, sublingual, minor salivary glands is seldom found in the parotid. Calculus, the common cause of salivary gland dysfunction is usually identified in submandibular salivary gland because of its duct anatomy and physiochemical characteristic serous secretion. We report an unusual case of co-existent presentation of ACC with salivary calculi in the parotid gland which is never been reported in the literature. Co-existence of ductal calculi and ACC is rare. Presence of parotid calculus could be due to long standing ductal obstruction by the slow-growing ACC of the parotid or other possibility is that the malignancy could have developed because of chronic irritation by parotid calculi. Confirmatory studies are required to understand its mutual pathological association.

Inverted papilloma of atypical origin with unusual extension into the oropharynx.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.

Melioidosis of salivary glands with coexisting diabetes: management of a difficult case.

Melioidosis is an infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic in Southeast Asia and northern Australia. An important risk factor for the development of melioidosis is the presence of diabetes mellitus, which may increase the relative risk of infection by as much as 100-fold. We report a rare case of melioidosis of the parotid and submandibular gland with coexisting diabetes. This was successfully managed conservatively with intravenous ceftazidime followed by trimethoprim/sulfamethoxazole and doxycycline.

Clinical, biochemical & cytomorphologic study on Hashimoto's thyroiditis.

BACKGROUND & OBJECTIVES: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto's thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. METHODS: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. RESULTS: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. INTERPRETATION & CONCLUSIONS: Our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.

Cervical thymic cyst: a rare differential diagnosis in lateral neck swelling.

Introduction. Thymic cysts are among the rarest cysts found in the neck. Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen in 50% of cervical thymic cysts. Case Report. We report an uncommon case of a 15-year-old male, who noted a painless, growing mass on left side of his neck of one-year duration. Computerised tomographic scan showed a multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level. Here, we discuss the surgical aspect, histopathology, and management of this rare lateral neck swelling. Discussion. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis.

Maltoma of thyroid: a rare thyroid tumour.

Introduction. Primary thyroid lymphomas constitute up to 5% of all thyroid malignancies and can be divided into non-Hodgkin's lymphomas (NHLs) of B- and T-cell types, as well as Hodgkin's lymphomas. Mucosa-associated lymphoid tissue (MALT) lymphomas are a relatively recently recognized subset of B-cell NHLs, and they are listed as extranodal marginal zone lymphomas according to the revised European-American lymphoma classification. Case Report. We report an uncommon case of a 44-year-old man, who noted a painless, growing mass on right side of his neck of the three-month duration. Thyroid profile was within normal limits. FNAC showed lymphocytic thyroiditis. The patient underwent a right hemithyroidectomy. The histologic examination and the immunohistochemistry showed an extra nodal marginal B-cell type maltoma (malt lymphoma). CHOP chemotherapy with rituximab was given. The clinical course has been favourable in the first year of followup, with no evidence of local or systemic recurrence of the disease. Discussion. Marginal zone lymphoma encompasses a heterogeneous group of B-cell tumours that variously arise within the lymph nodes, spleen, or extranodal tissues. A case of maltoma of thyroid is presented for its rarity and diagnostic dilemmas. Conclusion. Maltomas are slow-growing lymphomas. The optimal treatment and followup of patients with thyroid maltomas remain controversial at present.

Success of myringoplasty: our experience.

The purpose of this study is to compare the efficacy of myringoplasty with or without cortical mastoidectomy in terms of freedom from discharge, graft take up and improvement in hearing. This is a Clinical prospective study of 120 patients from among a group of patients with chronic suppurative otitis media. A detailed history and examination was conducted including pure tone audiogram. Patients were randomly divided into two groups; group A would undergo myringoplasty only and group B would undergo cortical mastoidectomy with myringoplasty. Patients were reviewed after 3 weeks for inspection of the operated ear. Second post-operative review was at 3 months for clinicoaudiological assessment. Group B was found to have slightly more improvement as compared to the other group. No significant difference in the success rates of graft take-up in patients with unilateral or bilateral disease was found. Higher take up rates were seen in large (91.83 %) and medium perforations (90.69 %). In all our failed cases, post-operative ear discharge continued to be a persistent and troubling problem. The average audiological gain was 12.88 dB in group B, whereas it was 12.40 dB in group A. The reduction of air bone gap within each group was found to be significant. There is no statistical significant data indicating that tympanoplasty with mastoidectomy yields better results. When considering the addition of a mastoidectomy to a Tympanoplasty, the performing surgeon should consider not only the potential added benefit but also potential risks and costs to the patient.

Infratemporal fossa abscess: a diagnostic dilemma.

An abscess in the infratemporal fossa is a rare complication of dental extraction. Although it is a recognized entity, only a handful of cases have been reported in the literature. We describe a case of abscess in the infratemporal fossa of a 55-year-old woman with noninsulin-dependent (type 2) diabetes who presented with left-sided facial pain and marked trismus. The abscess was managed successfully with external drainage. We have made an attempt to comprehensively review the literature on this rare condition, with special emphasis on its anatomic complexity and varied clinical presentation, and we provide a detailed discussion of the diagnosis and management of this condition.

Endobronchial metastasis from renal cell carcinoma: a case report.

A 46-year-old man had primary pulmonary symptoms of intermittent fever, cough and dyspnoea. Radiological investigations revealed a mass at right hilum with right upper lobe collapse. Bronchoscopy showed a luminal mass of which the biopsy showed a tumour with predominantly clear cell change. Subsequent investigations revealed primary renal adenocarcinoma. The differential diagnosis of clear cell lung tumour is discussed. This case of endobronchial metastasis from renal cell carcinoma is being presented because of its rarity.

Multifocal tuberculosis of the nose and lymph nodes without pulmonary involvement: a case report.

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.

Tuberculous retropharyngeal abscess.

Chronic retropharyngeal abscess caused by tuberculosis is rare. It should be suspected in a person who presents with a destructive lesion of the vertebra and a retropharyngeal mass. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present the case of a patient who came to our clinic with collapse of the C5-C6 vertebrae and retropharyngeal abscess. We were able to avoid any complications by initiating early surgical drainage and antituberculous therapy.

Sinonasal lymphoma: a case report.

Sinonasal lymphomas are uncommon malignancies. They are difficult to differentiate from carcinomas, and immunohistochemistry is needed to make the diagnosis. We describe an unusual case of a T cell lymphoma that involved only the paranasal sinuses in a middle-aged man. The patient presented with a complete loss of vision in one eye and lateral rectus muscle palsy, but no nasal symptoms.

Tuberculosis mimicking Kikuchi's disease.

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.

Benign lesions of larynx-A clinical study.

OBJECTIVE: A climical study was undertaken to analyze the age, sex distribution and symptomatology, sites of involvement and the prognosis of the common types of benign lesions of larynx. STUDY DESIGN: A five year retrospective study from 1997 to 2002. SETTING: KMC Hospital Attavar -A tertiary referral hospital. PATIENTS: A total of 42 patients with benign laryngeal lesions were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients ranged from 7-80 years. All non-operative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlyryngoscopic procedures were employed. RESULTS: A male preponderance with M:F ratio of 3∶1 was observed. Majority of the patients were in the 30-40 age group. Vocal polyps were the commonest type of lesion. In our study, hoarseness of voice, cough, foreign body sensation and throat pain proved to be the commonest symptoms. CONCLUSIONS: Micro laryngeal surgery and voice rest offer a cost effective, useful and safe method for management of benign laryngeal lesions.

Elongated styloid process (Eagle's syndrome): a clinical study.

PURPOSE: Elongated styloid process can be a source of craniofacial and cervical pain and remains a diagnostic challenge to many. The aim of the study was to determine the symptomatology and various criteria for the diagnosis of an elongated styloid process and its management. PATIENTS AND METHODS: Our clinical study consisted of 58 patients with elongated styloid process who had symptoms of vague cervicofacial pain and presented to our department during a period of 10 years. Special emphasis is given to palpation of the tonsillar fossa, lidocaine infiltration test, and orthopantomography. RESULTS: Minimal complications and zero incidence of deep neck infection were noted. CONCLUSIONS: All of the patients were managed surgically through the intraoral approach, which was found to be a safe procedure.

Antrochoanal polyps and allergy-A comparative study.

Antrochoanal polyps, are solitary polyps arising from the maxillary autrum. Their aetiology largely remains unknown; allergy has been implicated. The study attempts to define the relation between antrochoanal polyps and allergy and the need for such an investigation by studying 24 cases with antrochoanal polyps and comparing them with 20 cases of sinonasal polyps. Nasal smear cytology, serum total IgE and polyp fluid IgE was evaluated. 52.38% of cases turned out to be allergic. In their presentation, antrochoanal polyps do not significantly differ from other polyps.