Assessment of eustachian tube function in tympanoplasty.

OBJECTIVE: A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. STUDY DESIGN: Case series with planned data collection. SETTING: Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), a tertiary care center in South India. SUBJECTS AND METHODS: This study comprised 86 patients diagnosed with mucosal chronic otitis media in quiescent/inactive stage. All were subjected to a detailed clinical examination and investigations. Preoperative evaluation of ETF was compared with postoperative outcome of surgery, and the results were analyzed. RESULTS: The saccharin test and methylene blue dye test had a good correlation in evaluating ETF. The mean value for saccharin perception time and the clearance time for methylene blue were 17.5 and 8.1 minutes, respectively. ETF was best in anterior, worst among posterior, and intermediate in subtotal perforations. Type 1 tympanoplasty was successful in 94 percent with normal ETF and in 68 percent with partial dysfunction. CONCLUSION: The saccharin test is a simple, cost-effective, and valuable diagnostic tool to assess the mucociliary function of the ET. The outcome of middle ear surgery would be a success in normal ETF, whereas in partial dysfunction the outcome need not necessarily be a failure.

Chondroma of the nasal bone: a case report.

Cartilaginous tumors are common in the long bones of the body and relatively rare in the head and neck. When they do occur in the head and neck, the most common site is the midface. Since the first case report by Morgan in 1842, approximately 150 cases of head and neck chondroma have been recorded in the English-language literature. In this article, the authors describe a new case in which a chondroma of the nasal bone caused an external nasal deformity in a 17-year-old boy. The lesion was excised via an external rhinoplasty approach. The authors believe that this is the first reported case of a chondroma arising from the nasal bone. The authors have made an attempt to comprehensively review the literature on this rare and controversial tumor and place special emphasis on its uncertain biologic nature. A detailed discussion of the diagnosis and management of this tumor is also included in this report.

Induction Chemotherapy with Cisplatin and 5-Fluorouracil in Advanced Head and Neck Cancers: A Short Term Response Evaluation.

BACKGROUND: Considering the uprising number of Head and neck cancer in the state with limited options of medical and surgical treatment, the focus of this study involved on chemotherapy in advanced Head and neck cancers. The aim of this study was to evaluate the efficacy and toxicity of combination of Cisplatin and 5-Fluorouracil (PF) as induction chemotherapy in patients in locally advanced squamous cell cancer of head and neck. MATERIALS AND METHODS: Forty four patients with previously untreated stage III -IV advanced and inoperable cases were included in this prospective study. Induction chemotherapy consisted of 3 cycles of Cisplatin 100mg/mt(2) as infusion on day 1, 5-Fluorouracil of 750mg/mt(2) on day 2, 5-Fluorouracil of 1000mg/mt2 as infusion on day 3 in an inpatient basis. Cycles were repeated with an interval of 21 days. Patients were evaluated within a period of 3 weeks at the end of completion of third cycle of chemotherapy. Post chemotherapy local therapy was individualized based on the response, site and stage of the tumour. RESULTS: Out of 44 eligible and evaluable patients, major dominance was noted in male group constituting 68%. After induction chemotherapy 58.8% of stage III experienced stable response, & 44% had partial response. In stage IV, 44% showed a stable response and 33.3% had partial response. But in comparison to primary tumour response and nodal response, which had a significant clinical response, the overall response of malignancy with respect to stage and site specificity was clinically insignificant. Moderate adverse reaction was noted in 47.6% and 42.1% had mild reactions. Majority of patients experienced grade 3 adverse events, of which anaemia in females and leucopenia in males pre-dominated. CONCLUSION: With the use of cisplatin and 5-FU as induction chemotherapy agents in advanced and inoperable squamous cell carcinoma of head and neck, a distinct benefit was seen in stabilizing the tumour from progression. But achieving a significant complete response to the same is of faint possibility. An alternate multidrug regimen or multimodality treatment would be ideal to gain the optimum results from induction agents. Toxicity related to chemotherapy usually is transient at therapeutic doses, and can be controlled by adequate prophylactic measures.

Oral Microflora: A Comparative Study in HIV and Normal Patients.

The study was designed to compare the oral microbiota in normal and HIV-infected individuals. The study tries to establish a significant shift in oral microflora in HIV-infected patients. Antibiotic sensitivity testing was performed to establish any rise in resistance against the antibiotics. It was a two and half year prospective study conducted in a tertiary care centre. The study group consisted of eighty subjects divided into two groups of control and HIV. The age range for this group was 9-75 years. The mean age in this group was 39.7 years. The male:female ratio was 2.75:1. Tuberculosis was the most common opportunistic infection in patients with HIV infection. The most common commensal micro organism isolated was the Viridans streptococci in 60% followed by Streptococcus pneumoniae in 23.33%. HIV Group: The most common commensal micro organism isolated was the Viridans streptococci in 42%; this was followed by the Micrococci spp. in 22% cases. S. pneumoniae was isolated in 6% of cases. The colony count for Viridans streptococci showed a heavy growth in 55.56% of cases in controls whereas the same in HIV group was 62.5%. Micrococcus spp. was isolated from 11 subjects in HIV group while it was not isolated from the controls. 50% subjects in the HIV group showed a heavy growth of Klebsiella spp. whereas controls showed only moderate and scanty growth. In patients with CD4+ T cell count less than 50 cells/µl we found a heavy colonization of the oral cavity with Micrococcus spp., Acinetobacter and Klebsiella spp. Viridans streptococcus was not isolated in any of the patients with CD4+ T cell count less than 50 cells/µl. As CD4+ T cells counts improved to 51-100 cells/µl Viridans streptococcus colonies returned and 37.5% patients showed a heavy growth. Micrococcus spp. colonies were isolated till the CD4+ T cells improved up to 300 cells/µl. At counts > 300 cells/µl the oral microbiota became comparable to that of the controls. Many of the opportunistic infections in HIV are caused by commensal bacteria which are otherwise harmless in a normal individual. Our study is unique in that such a study of the oral commensals in HIV patients has never been reported. We found an increased colonization of the oral cavity by Micrococcus spp. which is a normal commensal of the skin.

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.

Carcinoma ex pleomorphic adenoma of the maxillary sinus: a case report.

A 52-year-old woman presented to the ENT clinic with a huge swelling on the right side of her face that had originated 6 years earlier. The mass was ultimately diagnosed as a carcinoma ex pleomorphic adenoma of the maxillary sinus. Carcinoma ex pleomorphic adenoma itself is uncommon, and its origin in the maxillary sinus is very rare. We discuss the presentation, histopathologic picture, and management of this case.

Papillary carcinoma in a lingual thyroid: an unusual presentation.

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Giant mucocoele of the maxillary antrum: a case report.

Maxillary antral mucocoeles have an incidence of only 3-10%. Mucocoeles are more commonly seen in the frontoethmoidal region. We present one such rare case of a 52-year-old lady who came to us with complaints of pain and swelling of the left cheek of 4 months duration. Clinical examination and investigation revealed a giant maxillary sinus mucocoele which was duly treated surgically. We discuss its classical presentation and management since such large mucocoeles are not often seen in the maxillary sinus.

Role of estimation of arterial blood gases in the management of stridor.

AIM: We studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes. MATERIALS AND METHODS: It was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death. RESULTS: Out of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001). CONCLUSION: Early detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor.

Snuff-induced malignancy of the nasal vestibule: a case report.

The association between nasal snuff and malignancy is not well established. There is epidemiological evidence suggesting that oral tobacco when mixed with lime and betel leaves causes oral cancer in the Indian subcontinent. Similarly, snuff spiced with dried aloe has been reported to cause upper jaw malignancies in the Bantu tribes. The last reported case of nasal snuff causing cancer of the nose was described by John Hill in 1761. We describe here a case of a 69-year-old woman who developed a nasal vestibular malignancy after 30 years of snuff usage, and this, we believe, is the only reported case of nasal snuff causing cancer in the last 2 centuries.

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.

Effect of snuff on nasal mucosa.

PURPOSE: The inhalation of nasal snuff (powdered tobacco) is a common addiction in the Indian subcontinent. In the western world, there is a resurgence of interest in nasal snuff because it does have the morbidity associated with smoked tobacco. Very few studies have reported the long-term effects of snuff on nasal mucosa. The objective of the present study was to investigate the effect of long-term use of snuff on the nasal mucosa. MATERIALS AND METHODS: We conducted a retrospective study on 29 snuff users. We investigated the reasons for initiation of this particular form of addiction along with the clinical signs and symptoms of long-term snuff usage. At the time of the study, all patients complained of one or more nasal symptoms. Nasal obstruction and nasal discharge taken together were reported by 62.5% of patients. Gross mucosal edema of the septum and turbinates was the main finding on nasal examination. The absolute eosinophil count and total serum immunoglobulin E were elevated in 62.5% and 66.7% of patients, respectively. On skin prick test, 41% of patients reacted positively to snuff and 25% to tobacco. Histopathologic examination of the turbinates (16 patients) showed squamous metaplasia, capillary proliferation, capillary and venous dilatation, inflammatory cell reaction, subepithelial edema, and fibrosis. CONCLUSIONS: Much has been written about the advantages of nasal snuff over products that deliver tobacco smoke. Our study shows that snuff users, after long-term abuse, develop a form of chronic rhinitis, as a consequence of which they develop blocked and stuffy noses. We conclude that nasal snuff is not a suitable substitute for smoked tobacco because it does not avoid ill health.

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.

Radiotherapeutic effect on oropharyngeal flora in head and neck cancer.

The effect of radiotherapy on oropharyngeal bacterial and mycotic flora was studied. Thirty five patients were included from whom swabs were taken before and at the end of irradiation. Fifteen controls were included.It was found that Streptococcus pneumoniae was significantly decreased at end of irradiation, while there wan an increase in Staphylococcus aureus. Pseudomonas, Bacteroides and Candida species. There was no change in culture and sensitivity pattern prior to and after radiotherapy.

Presentation and management of deep neck space abscess.

OBJECTIVE: To study the presentation, etiology, microbiology and morbidity of deep neck space infections. STUDY DESIGN: Retrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997 and December 2002 with deep neck space infections.,were included in the study. REMITS: The most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7% of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic and anaerobic infections was identified in most of the cases.