Null-Cell Ectopic Pituitary Adenoma of the Nasal Cavity.

An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur anywhere along the migratory embryonic path of the pituitary gland and have no relationship to intrasellar elements. They are usually hormonally active and have a minor female predominance. The clinical features of EPAs are highly dependent on its hormonal activity, anatomical location, and its local mass effect. Appropriate radiological imaging is essential for the evaluation of EPAs. Imaging investigations show a normal pituitary gland and sellar turcica, provide details on the size of the tumor, its margins, and extent, and help with surgical planning. The criteria for diagnosing an ectopic pituitary adenoma depend on detailed histopathological examination. EPA management should be individualized. We present a case of a 71-year-old male who presented with a 9-month history of left nasal obstruction, purulent nasal discharge, and intermittent anterior epistaxis. The patient was being managed by his general practitioner for chronic rhinosinusitis but failure of his symptoms to resolve prompted a visit to the otorhinolaryngologist. The patient was diagnosed with a null-cell ectopic pituitary adenoma through histological analysis of a biopsy specimen that showed adenohypophyseal cells without cell-type-specific differentiation. The patient subsequently underwent an endoscopic endonasal excision and had an uneventful hospital stay.

Pediatric-Onset Relapsing Polychondritis With Otolaryngeal Manifestations.

Relapsing polychondritis (RP) is a rare autoimmune disease that can present with various clinical manifestations. Among the affected sites, the ear, nose, and throat cartilages are frequently involved, often leading to subtle and episodic symptoms that can be challenging to diagnose. A high index of suspicion is necessary for the early identification of these subtle signs, which can aid in early diagnosis and prompt management. In this report, we present a rare case of pediatric-onset relapsing polychondritis that was initially misdiagnosed as laryngotracheobronchitis.

ALK-Positive Anaplastic Large Cell Lymphoma: A Diagnostic Dilemma for the Otolaryngologist in a Resource Poor Setting.

Anaplastic large cell lymphoma is a rare subtype of non-Hodgkin's lymphoma. The morphological diversity with which its anaplastic cells confer make the diagnosis of this hematological entity extremely challenging to the pathologist in a resource poor setting. We present a case of a 35-year-old male with a nasopharyngeal mass and cervical lymphadenopathy and the adversities faced by out otolaryngology department with obtaining the diagnosis of ALK-positive anaplastic large cell lymphoma.

Doxycycline Sclerotherapy of a Cervical Cystic Hygroma: A Caribbean Institution Experience.

Cervical cystic lymphangiomas are rare benign tumors that pose a formidable challenge to surgeons confronted with managing this uncommon entity. Due to the intimacy with which these cystic lesions blend with critical cervical structures, a considerable number of patients who undergo surgical management are often plagued with recurrence and morbidity. As a result, doxycycline sclerotherapy has become an attractive, safe, and effective alternative as a primary treatment modality in a select group of pediatric patients. This case report presents an 18-month-old patient with a large cervical cystic hygroma that was effectively treated with exclusive doxycycline sclerotherapy.

Cervical scar satisfaction post conventional thyroidectomy.

BACKGROUND: Thyroidectomy is a commonly performed procedure with large centres performing thousands of thyroid surgeries per year. The traditional Kocher mid-cervical incision has been the standard approach to thyroidectomy since the late 1870s with predictable results. The introduction of minimally invasive and remote access techniques seeks to reduce the morbidity of a mid-cervical scar incision. METHODS: Ninety-five [95] patients who underwent this approach over the thirty [30] months period from January 2015 to July 2017 were administered the validated Patient Scar Assessment Questionnaire and the collected data analysed. RESULTS: Forty-eight [48] patients, (50.5%) met inclusion criteria and provided responses with a mean time since surgery of 18.9 months. There is a high level of satisfaction with 91.7% of patients in the study having scores consistent with scar satisfaction after conventional thyroidectomy. While patients were satisfied with the appearance of their scars, a majority of patients (n=28, 58.3%) were at least slightly conscious of their incisions, with more than 10% of patients (n=5) reporting significant levels of self-consciousness. Patients of Mixed race were found to have slightly elevated scores on PSAQ compared with IndoTrinidadian and AfroTrinidadian races (P=0.002 and P=0.006). CONCLUSIONS: Most patients were satisfied with their scar results in the years after thyroidectomy. Despite the high level of satisfaction, a majority of patients are self-conscious about the presence of a mid-cervical incision. Further research is needed to elucidate causes and the effects of this finding.

Epidemiology of salivary gland tumours in an Eastern Caribbean nation: A retrospective study.

OBJECTIVE: The epidemiology of the salivary glands tumour is not well documented in the Caribbean countries. Therefore, the aim of this study is to determine the local trend of salivary gland tumours with a review of current diagnostic techniques. DESIGN & METHODS: Retrospective data was collected from the electronic database at the Pathology department of the San Fernando Teaching Hospital between the periods January 2005 to June 2015. All patients who underwent primary resection of either the parotid, submandibular or minor salivary glands for diagnosed tumour cytologically or suspected tumour were included in this study. The clinical and histopathological data were then collected and analyzed. RESULTS: A total of 85 surgeries were performed for suspected or diagnosed neoplasia, 54 parotidectomies, 26 submandibular gland and 5 minor salivary gland excisions. The benign neoplastic lesions, pleomorphic adenoma and Warthin's tumour, were the most common 53 (62.4%) of all the resections performed, followed by non-neoplastic lesions 25 (29.4%) such as sialadenitis, cysts or normal glands. Malignant neoplasms made up the minority with only 7 cases whereby mucoepidermoid carcinoma was the most common malignant neoplasm found followed by squamous cell carcinoma. CONCLUSION: Parotid gland remains the most frequent site of salivary gland tumours (80%), with pleomorphic adenoma being the most common benign tumour. Triple assessment is still required to manage these cases adequately with stress on preoperative tissue diagnosis FNAB vs USS guided core biopsy.

Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge.

Odontogenic cutaneous fistulas often lead to intense levels of patient discomfort and suffering. Due to its rarity and the absence of dental symptoms, a considerable number of patients are usually misdiagnosed which results in inappropriate management. This case report presents a 16-year-old patient with a 2-year history of a nonhealing, persistently discharging lesion in the left submandibular region of the neck. The patient underwent exploration of the left submandibular region, and a fistulous tract directed superomedially to the ipsilateral lower molar teeth was excised. A subsequent panoramic orthopantomogram performed one week postoperatively demonstrated radiolucency is the distal root of tooth 37. A final diagnosis of odontogenic cutaneous fistula was made, and the patient was referred to the Maxillofacial Department for treatment of the offending tooth.

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Selected bacterial recovery in Trinidadian children with chronic tonsillar disease.

Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3 per cent), Staphylococcus spp. (42.3 per cent) and Gram-negative genera (6.4 per cent). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2 per cent) than cores (63.3 per cent) grew Streptococcus spp.; a-haemolytic Streptococcus prevalence was higher (p<0.001) than B-haemolytic Streptococcus on surfaces (74.4 per cent vs. 18.6 per cent) than cores (58.9 per cent vs. 13.7 per cent). Surfaces and cores were not concordant for streptococci (p<0.0004) and   haemolytic Streptococcus (p<0.007). Surface and core B-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31 per cent and 23.8 per cent vs 12.5 per cent and 8 per cent). S. pyogenes surface and core prevalence was (84.6 per cent vs 70 per cent) and (50.0 per cent vs 25.0 per cent) in older and younger children respectively. Klebsiella spp. (6.6 per cent, 2.2 per cent), Proteus (4.4 per cent, 4.4 per cent) and Pseudomonas (4.4 per cent, 1.1 per cent) grew on surfaces and cores respectively.

Achado de bactérias selecionadas em crianças de Trinidad com doença amigdaliana crônica / Selected bacterial recovery in Trinidadian children with chronic tonsillar disease

Faringoamigdalite na população pediátrica é largamente tratada com antibióticos. OBJETIVO: Estudar a microflora presente na superfície e no núcleo de amígdalas após adenoamigdalectomia eletiva em crianças. MÉTODO: Amígdalas de 102 crianças de Trinidad foram prospectivamente estudadas por meio de culturas e identificações bacteriológicas feitas a partir de amostras das superfícies e núcleos de suas amígdalas entre 2005-2006. RESULTADOS: A partir de 360 amígdalas, foram isolados Streptococcus spp. (51,3 por cento), Staphylococcus spp. (42,3 por cento) e Gram-Negativos (6,4 por cento). A identificação de estafilococos e estreptococos tanto na superfície quanto no núcleo foi semelhante (p>0,05). Encontramos mais (p<0,001) Streptococcus spp. nas superfícies (82,2 por cento) do que nos núcleos (63,3 por cento); a prevalência de estreptococos alfa-hemolíticos foi maior (p<0,001) do que aquela de estreptococos beta-hemolíticos nas superfícies (74,4 por cento vs. 18,6 por cento) do que nos núcleos (58,9 por cento vs. 13,7 por cento). Não houve concordância entre superfícies e núcleos com relação a estreptococos (p<0,0004) e estreptococos alfa-hemolíticos (p<0,007). Estreptococos beta-hemolíticos foram mais identificados (p<0,05) em crianças dentre 6-16 anos do que naquelas entre 1-5 anos de idade (31 por cento e 23,8 por cento vs 12,5 por cento e 8 por cento). A prevalência de S. pyogenes na superfície e no núcleo foi de (84,6 por cento vs 70 por cento) e (50,0 por cento vs 25,0 por cento) em crianças de maior faixa etária e crianças mais novas, respectivamente. Klebsiella spp. (6,6 por cento, 2,2 por cento), Proteus (4,4 por cento, 4,4 por cento) e Pseudomonas (4,4 por cento, 1,1 por cento) cresceram nas superfícies e núcleos, respectivamente. CONCLUSÃO: As superfícies amigdalianas tinham mais estreptococos e estreptococos hemolíticos do que seus núcleos. Crianças mais velhas tiveram mais estreptococos beta-hemolíticos, e são altamente colonizadoras...

Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3 percent), Staphylococcus spp. (42.3 percent) and Gram-negative genera (6.4 percent). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2 percent) than cores (63.3 percent) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than ß-haemolytic Streptococcus on surfaces (74.4 percent vs. 18.6 percent) than cores (58.9 percent vs. 13.7 percent). Surfaces and cores were not concordant for streptococci (p<0.0004) and α-haemolytic Streptococcus (p<0.007). Surface and core ß-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31 percent and 23.8 percent vs 12.5 percent and 8 percent). S. pyogenes surface and core prevalence was (84.6 percent vs 70 percent) and (50.0 percent vs 25.0 percent) in older and younger children respectively. Klebsiella spp. (6.6 percent, 2.2 percent), Proteus (4.4 percent, 4.4 percent) and Pseudomonas (4.4 percent, 1.1 percent) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for α haemolytic streptococci. Older children grow more β-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested.

Selected bacterial recovery in Trinidadian children with chronic tonsillar disease.

UNLABELLED: Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3%), Staphylococcus spp. (42.3%) and Gram-negative genera (6.4%). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; alpha-haemolytic Streptococcus prevalence was higher (p<0.001) than ss-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were not concordant for streptococci (p<0.0004) and alpha-haemolytic Streptococcus (p<0.007). Surface and core ss-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs 70%) and (50.0% vs 25.0%) in older and younger children respectively. Klebsiella spp. (6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for alpha haemolytic streptococci. Older children grow more beta-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested.

Hearing loss in steelband musicians.

OBJECTIVE: To determine the difference in hearing between a group of steelband musicians (pannists) and a control group. DESIGN, SETTINGS, AND SUBJECTS: We conducted a controlled cross-sectional pilot study consisting of 29 steelpan players and 30 control subjects from a steelpan orchestra (steelband) in the Otolaryngology Department of the Eric Williams Medical Sciences Complex. RESULTS: Significantly more steelpan players had a hearing loss than the control subjects at 3000 Hz, 4000 Hz, and 6000 Hz ( P < 0.01). chi 2 testing for trend demonstrated that the longer a steelpan player played his instrument the greater the hearing loss. CONCLUSION: These results indicate that pannists suffer permanent auditory damage from high-intensity sound levels and that preventative measures are required to prevent this hearing loss, particularly in younger players.

Ethnic differences in otitis media [abstract]

The comparative incidence of Otitis Media (OM) has long been difficult to ascertain as almost all previous epidemiological studies were performed in comparatively homogenous populations. In an attempt to question the racial variation of OM, a study was done in Trinidad, with a population of 1.2 million people. About 40 percent of the population is of African ancestry, 40 percent of East-Indian ancestry and 20 percent includes persons of mixed ethnicity, Caucasian, Chinese and middle-Eastern descent. All patients who presented with acute otitis media (AOM), middle ear effusion (MEE), or chronic suppurative otitis media (CSOM) either of the tubo-tympanic (TT) or attico-antral (AA) types, during the period November 1998 to May 1999, were included in the study. The three national otolaryngology Departments participated in the study suggesting that patients were representative of the whole population. A questionnaire was devised with documented ethnic and other demographic factors. This was completed once an experienced physician diagnosed the patient with one of the above conditions. Two hundred and fifty-two patients enrolled in the study. There were 128 males and 124 females and the age range was 4 months to 83 years. Sixty patients presented with AOM, 88 with MEE and 104 with CSOM. The most interesting result was the ethnic distribution of the patients. One hundred and thirty-eight were of East-Indian descent and 71 were of African origin, a ratio of nearly 2:1. In conclusion, in a national population containing nearly equal numbers of two major ethnic groups, the East Indians presented twice as commonly as the Africans with otitis media. Various proposed reasons for this will be discussed. (AU)

Transsphenoidal pituitary tumour surgery in Trinidad and Tobago - Poster abstract

OBJECTIVE: To determine whether the transsphenoidal approach for pituitary tumours is advantageous over the traditional transcranial approach. DESIGN andMETHODS: Retrospective analysis of consecutive patients who underwent transsphenoidal (TS) and transcranial (TC) procedures for pituitary tumor during January 1998 to September 1999. Age, gender, presenting symptoms, preoperative findings, endocrine and imaging studies, operative procedure, complications,outcome, hospital stay, cost and patient satisfaction were recorded and analyzed. RESULTS: There was atotal of 15 cases (8 TS and 7 TC). The male to female ratio was 1:2, with an age range 10 to 71 years.All presented with visual impairment, 10 with headaches and 5 with hyperprolactinaemia. Average operative time for TS procedure was 2 hr 55 min and for TC, 2 hr 12 min. Average hospital stay for TS cases was 5.3 days whereas TC patients stayed for 5.7 days. Average cost of hospitalization (excluding fees for the surgeons and anaesthetists) for TS patients was significantly lower than for the TC patients (p<0.001). Patient satisfaction mean index for TS cases was 4.125 while it was 3.71 for TC cases. Three TS patients had excellent satisfaction. There were no mortalities. CONCLUSION: The TS approach has certain advantages compared to the TC approach in the management of pituitary tumors. TS approach is recommended in selected cases in our setting in Trinadad and Tobago. (Au)

Trends in asthma visits to accident and emergency centres in Trinidad during 1997 and associations with climate variables

OBJECTIVES: To describe trends in asthma visits to Accident and Emergency (A&E) facilities during 1997 and to examine their associations with climatic conditions. DESIGN AND METHODS: A census of patients with asthma, defined as those who required brochodilator nebulization, was taken at five A&E facilities in Trinidad. Data on patients' age, gender and date of visit were obtained from the A&E records and, climate variables, including rainfall, temperature, relative humidity, and wind speed, were obtained from the Meteorological Office. RESULTS: There was a total of 27,848 asthma visits to the five facilities during 1997, of which the paediatric population(<16 years) accounted for 43 percent. There were steady increases in adult and elderly visits from January to December. A sharp increase in paediatric visits was observed in September, which coincided with the start of the school year. The results of multiple regression analysis indicated that paediatric visits to the A&E were positively associated with temperature and wind speed, while adults' visits were positively associated with temperature and relative humidity. None of the climatic variables predicted asthma visits in the elderly. CONCLUSION: There is a need for further research to explain the increase in paediatric visits at the start of the school year as well as to elucidate the mechanism for the observed associations between climate and asthma visits. (Au)

An analysis of asthma admissions to Accident & Emergency Departments at four centres in Trinidad for the period January 1 - June 30, 1997

We report on the demographic features of 11,869 asthmatic patients who made 14,074 visits to four Accident & Emergency (A & E) Departments for bronchodilator nebulisation during the first half of 1997. Most patients (30 percent) were between 3 and 12 years old. There was a male predominance in the paediatric population and in patients aged 60 years and over. Female patients exceeded males from the second to fifth decades. Female to male ratios were highest during the third and fourth decades. Admission figures in the different centres showed fewer patients attending in January and April with increase admissions in February and March. The A&E service at Chaguanas differed from the other centres in having a marked increase in admissions during May.(AU)

Allergic rhinitis and skin prick testing in Trinidad

This study investigated a group of 17 patients in Trinidad who were diagnosed as having allergic rhinitis following the criteria set out by the International Rhinitis Management Working Group: the presence of two or more of these symptoms (sneezing, blockage, running nose - including drainage of mucus down the back of the throat) for more than one hour a day for more than two weeks. These patients had skin prick testing performed with a panel of common allergens. Of the 17 patients tested, 76.4 percent reacted to Dermatophagoides pteronyssinus and 52.9 percent reacted to house dust. In conclusion, it appears that Dermatophagoides pteronyssinus is a common allergen involved in allergic rhinitis in Trinidad.(AU)