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ABSTRACT: Objective. To report a rare presentation of pleomorphic adenoma, at base tongue, excised surgically by a transoral midline glossotomy technique without mandibulotomy. Case Report. Pleomorphic adenoma is a benign tumor of the salivary gland found rarely in the base of tongue. Surgery is the definitive treatment for this tumor, and different approaches have been mentioned in the literature. In our case we surgically excised the tumor by a transoral midline glossotomy technique without mandibulotomy where we combined the cosmetic advantage of transoral technique and the exposure advantage of a glossotomy technique. Discussion. We discuss the different approaches to oropharynx, their advantages and disadvantages. Primary transoral approach provides better cosmesis but less exposure whereas median labiomandibuloglossotomy approach provides more exposure but is cosmetically unacceptable. Conclusion. A transoral midline glossotomy approach without mandibulotomy provides wide exposure with acceptable cosmesis.
Case reports in otolaryngology. 01/2012; 2012:851501.
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ABSTRACT: Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications. Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway. Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.
Case reports in otolaryngology. 01/2012; 2012:450304.
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ABSTRACT: Allergic rhinitis is associated with excess specific immunoglobulin E. Inner ear involvement (via both cellular and humoral immunity) is poorly understood, but appears to arise from the endolymphatic sac and duct.
To assess the otological and audiological status of patients with allergic rhinitis.
Thirty allergic rhinitis patients (14 men, 16 women; age 17-45 years, mean 31 years) and 20 controls (12 men, eight women; age 21-42 years, mean 27 years) underwent audiological investigation.
All study group patients had sensorineural (rather than conductive) hearing loss, worse at high frequencies. All had abnormal transient evoked otoacoustic emissions and 27 had abnormal distortion product otoacoustic emissions. All had a statistically significantly prolonged wave I latency, and shortened absolute wave I-III and I-V interpeak latencies, compared with controls.
Allergic rhinitis patients had a higher prevalence of hearing loss and otoacoustic emission abnormalities than controls. The endolymphatic sac can process antigens and produce its own local antibody response; the resulting inflammatory mediators and toxic products may interfere with hair cell function. Additional research is needed to determine the clinical value of audiometry and otoacoustic emission testing in allergic rhinitis.
The Journal of Laryngology & Otology 09/2011; 125(9):906-10. · 0.60 Impact Factor
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ABSTRACT: To formulate a protocol for infant hearing screening in developing countries enabling it to be later incorporated into their national deafness screening programs. The screening tool should be sensitive in detecting hearing loss in infants with high specificity.
2659 infants in the age range of 0-3 months who reported to the Department of Otolaryngology were included in the study. As 537 children were lost to follow up after the first screening, the remaining 2122 infants only were considered for the statistical analysis. These were divided into 3 groups with age range between 0-1, 1-2 and 2-3 months of age. All were subjected to transient evoked otoacoustic emission (TEOAE) for hearing screening. Those who failed first screening were followed up after 1-month. Pass rate for TEOAE was calculated for each. Infants who had failed the second screening underwent Brainstem Evoked Response Audiometry (BERA). The data collected was statistically analyzed.
77.5% of infants in 0-1-month age group passed the screening test whereas 83.4% and 92.8% of infants passed the screening test in 1-2 months and 2-3 month age groups, respectively. On the first follow up, the pass percentage of the infants who had failed screening earlier rose significantly high up to age of 3 months. Those who had failed the follow up were scheduled for Brainstem Evoked Auditory testing.
The concept of this delayed hearing screening at 3 months of age would considerably decrease the number of false positive cases undergoing unnecessary investigations and wastage of resources making the universal neonatal hearing screening within 48 h of life impractical for developing countries. Combining this delayed hearing screening with the 3rd dose of universal immunization program would constitute a viable, feasible and universal hearing screening program, which can be drafted into national deafness programs of the developing countries.
International Journal of Pediatric Otorhinolaryngology 08/2008; 72(7):1059-63. · 1.17 Impact Factor
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ABSTRACT: To describe the technique and results of primary endonasal endoscopic dacryocystorhinostomy in children with nasolacrimal duct blockage and review of literature with comparison of the results in adults.
A prospective study was carried out between the months of January 2002 to December 2004, which included 18 patients. Patients diagnosed as having only nasolacrimal duct obstruction were included in this study and an endonasal endoscopic procedure was performed.
Eighteen children underwent endoscopic the DCR procedure. There were 5 males (27.7%) and 13 females (72.3%) with the maximum incidence between the age group of 4-7 years (age ranging from 10 months to 11.2 years). The follow up period ranged from 6 to 19 months average being 8.2 months. Relief of symptoms and endoscopic visualization of the patent stoma made into the lacrimal sac with sac syringing determined a successful outcome. Seventeen patients (94.4%) fulfilled the criteria.
Our experience suggests that endonasal endoscopic DCR without stenting offers the same success rates for primary surgery over external DCR as have been established in adults. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of stent related complications.
International Journal of Pediatric Otorhinolaryngology 08/2006; 70(7):1213-7. · 1.17 Impact Factor
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ABSTRACT: Comparison of characteristic features, radiology, management and recurrence pattern of fungal sinusitis between children and adults.
A prospective study conducted in the department of Otorhinolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh in which all the cases presenting with the features of allergic fungal sinusitis (AFS) between January 2000 and January 2005 were enrolled. These cases were divided into two groups, group 1 comprised of cases with age less than 15 years and group 2 with age more than 15 years. Detailed history, physical examination and nasal endoscopic examination and computed tomography (CT) scan of the paranasal sinuses was done in all the cases. The cases with prior history of sinonasal surgery were excluded from the study. All patients refractory to medical management were subjected to endoscopic sinus surgery. All the cases were followed up for a period ranging from 6 to 39 months to see for the recurrence. The data of both the groups was analysed statistically using chi square test.
The study population comprised of 200 cases, with 68 cases in group 1 and 132 cases in group 2. The most common symptom in both the groups was presence of nasal obstruction. The children had higher incidence of having unilateral disease (46 out of 68) compared with adults, where it was 38 out of 132. The bony erosion was seen more often in group 1. Surgery was done endoscopically in all the cases. The intra orbital or intra cranial extension was seen in 58 cases of group 1 and 47 cases of group 2 (p<0.001). Recurrence was seen in 18 (15 with intraorbital and 3 with intracranial extension) cases in group 1 and 13 cases (11 with intraorbital and 2 with intracranial extension) in group 2 (p<0.005).
In our study, we found a higher incidence of facial deformities, proptosis, intraorbital/intracranial extension and a higher rate of recurrence in group 1, therefore, suggesting a more aggressive nature of AFS in children than adults mandating an early diagnosis, proper management and regular follow up in these cases.
International Journal of Pediatric Otorhinolaryngology 04/2006; 70(4):603-8. · 1.17 Impact Factor
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ABSTRACT: Pleomorphic adenomas arise most commonly in the major salivary glands; the minor salivary glands are affected in only 8% of the cases. Intranasal pleomorphic adenoma being extremely rare originates most commonly from the nasal septum. We present a case of a 55-year-old man who presented with complaints of right-sided nasal obstruction and occasional nasal bleed for the last 6 months. Examination showed a mucosa-covered, fleshy 2 x 2 x 1.5 cm mass in the right nasal cavity. Computed tomogram showed right-sided polypoidal mass with attachment to the cartilaginous nasal septum without any erosion of the surrounding structures. The clinical presentation, gross and microscopic appearance, and treatment of intranasal pleomorphic adenoma is briefly discussed.
American Journal of Otolaryngology 25(2):118-20. · 0.87 Impact Factor
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ABSTRACT: Mucormycosis of the paranasal sinuses represents an important cause of morbidity and mortality in patients whose host defenses have been altered by primary disease or immunosuppressive therapy. The pattern of involvement by this fungus is changing with reports of mucormycosis occurring also in immunocompetent host. The involvement of isolated sphenoid sinus is rare. In the present case, the only presenting symptom was visual impairment. These changing trends in presentation, the extent, and the area of involvement are challenging for the otorhinolaryngologist, ophthalmologist, and neurosurgeon. High index of suspicion, prompt intervention, and aggressive therapy are required to reduce the morbidity and mortality associated with this disease.
American journal of otolaryngology 31(1):64-6. · 0.77 Impact Factor
