Hearing loss is a leading cause of disability in China. However, the research status in the field of hearing among Chinese individuals in the three major regions of China: Mainland (ML), Hong Kong (HK) and Taiwan (TW), are unknown. The output of hearing articles published in international otorhinolaryngology journals from these three regions were compared in this study. Articles published in 31 international otorhinolaryngology journals related to hearing originating from the ML, TW and HK from 2000 to 2011 were retrieved from the PubMed database search. The number of total articles, clinical trials, randomized controlled trials, case reports, and articles published in the top 5 international otorhinolaryngology journals were assessed in terms of quantity and quality comparisons. The total number of articles from the three regions increased significantly from 2000 to 2011. There were 379 articles from ML (143), TW (180) and HK (56) in the past 10 years. The number of articles published per year from the ML has exceeded those from TW in 2009 and HK in 2003. TW had the most articles (46) published in the top 5 international otorhinolaryngology journals among the three regions. The total number of articles from the three major regions of China increased significantly from 2000 to 2011. The numbers of articles published per year from the ML have exceeded those from TW and HK. However, the quality of articles from TW is better than that from ML.
BERA (BSER OR BAEP) has proved to be useful tool in diagnosing hearing impairments in children which could be conductive or sensorineural in nature. Because of early detection the rehabilitative procedures could be started early which will help speech and language development.We have studied 150 cases below 5 years age and our observations are recorded with case history profile like high risks, referral for adoptions, congenital malformations and delayed speech. We fell Bera is the only tool which can give accurate picture of hearing sensitivity.
150 patients with mass lesions in the head and neck area, excluding the CNS and thyroid gland were subjected to FNA cytodiagnosis. II out of 150 smears were considered unsatisfactory for diagnostic evaluation. Out of the 139 patients who yielded satisfactory smears, cytodiagnosis led to the following broad categories - inflammatory and non- neoplastic (24/139, 17.3%), benign neoplasm (60/139, 43.2%), suspicious for malignancy (14/139. 10%) and malignant neoplasms (41/139, 29.5%). Histopathologic follow- up was available in 120 cases. 15/24 with inflammatory lesions were not subjected to biopsy, rest 4 were lost to follow up (I had a suspicious smear and 3 the diagnosis of benign neoplasm). Correlation of cytodiagnoses with histopathology yielded the following results - 52 out of 57 patients with the cytodiagnosis of benign neoplasm and having, histologic follow up had concordance, while 39 out of 41 cytologic diagnoses of malignancy, correlated with histopathology.Out of surgically sampled 9 patients, with inflammatory smears, 8 were benign and 1 malignant. In the suspicious category 2 out of 13 surgically sampled patients had malignancy. Thus, excluding the suspicious smears the accuracy of diagnosis by FNAC in this study came to 93% and a sensitivity for cancer detection of 95%. We encountered a false negative rate of 9.0% and a false positive rate of 4.9%.The results are discussed, especially in the light of the misdiagnoses and ways at avoiding diagnostic : error.
Nasopharyngeal Angiofibroma is a relatively rare benign, but locally aggresive tumor of the nasopharynx afflicting the adolescent males. The management of these tumors has been a subject of much interest and controversy in the past Here we present a series of 19 patients of nasopharyngeal angiofibroma (with CT Scan as the main stay of diagnosis) managed over the last 5 years at ENT and Head & Neck Surgery Department of S.S.G. Hospital, Vadodara, with infraoperative internal maxillary artery ligation via the trans maxillary approach permitting accurate removal of tumor with no major post operative complications, minimal blood loss, good cosmetic result and no recurrence till date. If further experience with this approach to management in a larger series of patients has the same results, surgery should be the gold standard in treatment of Nasopharyngeal angiofibroma.
Rigid Bronchoscopy is carried out for the diagnosis and removal of the foreign body. The post operative period may have complications like laryngobronchial spasm, laryngeal oedema, in turn may require tracheostomy and later on may lead to cardiac arrest and respiratory arrest. These post operative complications can be drastically reduced by the use of nebulization with the combination of steroids, Bronchodilators and lignocaine. Combination with lignocaine nebulization reduces rates of morbidity and mortality effectively then nebulizing only steroid and bronchodilators. Lignocaine reduces the irritative cough, reactive secretion and also hence bronchospasm and also vomiting.
Two hundred cases of chronic suppurative otitis media with dry ear were taken up for myringoplasty operation by underlay technique through transcanal route. Autologous temporalis fascia was used as the graft material in all cases. Surgery was done during the period from April 1987 to November 1992. The patients were reviewed 5 years after the surgery  and analysed.
272 Patients with obstruction in nasolacrimal duct were treated by endoscopic nacryocystorhinostomy (DCR). The results were compared with that of external DCR and Endoscopic DCR without stent. In our study Endoscopic DCR with stening had better results. Endoscopic DCR with stenting has several advantages over the more conventional external approach and Endoscopic DCR without stenting. Results at 4 years of follow up have been good that is 98.6% patients were relieved of symptoms completely.
Stylalgia is a pain syndrome occurring in connection with on elongated or malpositioned styloid piocess and is more common than generally thought. 332 cases of stylalgia were diagnosed over a period of 15 years. The charcteristic symptoms were chronic throat pain during swallowing with referred otalgia or referred pain to cheek or lower part of neck associated with foreign body sensation in throat. Movements of head or act of deglutition initiates or increases the pain The diagnosis of stylalgia is based on symptoms, palpation of enlarged styloid process mtraorally in the tonsillar region and elicitation of similar nagging throat pain or pain in the neck or foreign body sensation in the throat. Confirmation of enlarged styloid process is always done by radiological examination of styloid process per orbital view. Bilateral enlargement of tyloid process were found in 196 patients (59.03%) and unilateral enlargement was found in 136 (40.96%) patients. All the patients were operated under local anaesthesia by intra oral route without any complications.
36 patients with advanced squamous cell carcinomas of the maxillary sinuses formed the basis of this review. There were 16 T3 and 20 T4. Treatment consisted of radiotherapy alone in 21 cases and radiotherapy followed by systemic chemotherapy in 15 cases. The median survival for all analysed patients was 19 months and the 3-year and 5-year estimated survivals were 30% and 17%. The respective 3-and 5-year survival probabilities were 19% and 9% for patients treated with radiotherapy alone and 40% and 27% for patients treated with radiotherapy and chemotherapy (p= 0.01). Our findings seem to suggest that the addititon of systemic chemotherapy to radiotherapy may imporve overall survival in advanced squamous cell carcinomas of the maxillary sinuses.
Tone burst evoked auditory brainstem responses and auditory steady state responses with 40 or > 80 Hz modulation can be used to determine frequency specific threshold.
The present study was taken up to check for the efficacy of estimating hearing thresholds by tone burst ABR and ASSR. The frequency effect (low, mid and high) on estimating the threshold was also focused upon.
20 normal hearing adults (40 ears) in the age range of 16 to 30 years participated in the study. The pure tone audiometry and immittance was initially done. Subsequently, tone-burst ABR, 80Hz ASSR and 40Hz ASSR to estimate the threshold with three frequencies 500Hz (low), 2000Hz (mid) and 4000Hz (high) was done. The data was analyzed statistically using pair sample t-test.
ASSR threshold for 80Hz and 40Hz was almost comparable. ASSR was superior to estimate the threshold than tone-burst ABR. For the low frequency the discrepancy between the behavioral threshold and frequency-specific evoked audiometry was more when compared to mid and high frequency.
Present study showed that steady-state responses were efficient means of threshold detection than visual detection of ABR wave-V. In awake adult subjects, 40Hz and 80Hz amplitude modulated produced similar results. For the threshold estimation ASSR was better than tone-burst ABR.
Acute epiglottitis is a potentially life threatening condition which can lead to fatal airway obstruction in previously healthy individuals. The present study was undertaken to assess the clinical features, management and patient outcomes of epiglottitis in Kuwait over an eight year period.
Al Sabah Hospital, Kuwait.
All patients admitted to the ENT department of Al Sabah hospital between January 2000 and January 2008 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by visualization of inflamed epiglottis either on indirect laryngoscopy or flexible fibreoptic/direct laryngoscopy.
47 cases were identified, 5 children and 42 adults. There were 32 males and 15 females, in the age range of 5 to 66 years. Peak incidence was in the third decade. 31 patients had co-morbid conditions, 18 patients (38.2%) had diabetes, 8 patients (17%) had hypertension and 3 patients (6.3%) had dental caries. Majority of the patients (89.3%) presented with sore throat as their chief complaint. All patients were febrile on presentation. The classical "thumb sign" on lateral neck radiograph was seen in 32 patients (68%). Blood cultures were collected from 22 patients (46.8%), all were negative. Ceftriaxone was the commonest empirical antibiotic prescribed. 7 patients required airway intervention (5 with endotracheal intubation and 2 with tracheostomy). There were no deaths in our study.
In Kuwait, acute epiglottis is commoner in adults than in children. It is imperative to secure the airway and to start the patients on broad spectrum antibiotics and steroids as early as possible. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention, in the form of intubation / tracheostomy, for patients with stridor or shortness of breath.
A study of pathological lesions of the external ear was carried out during the period of two years. All 500 cases were grouped in four categories, Congenital, Injury, Infection and Cyst and Tumors. Distribution of lesions in age groups and both sexes was studied. Cases were examined to know the etiology, bacteriology and clinical presentation of the lesion. The results of the treatvent were evaluated.
Rhinosporidiosis, a difficult granulomatous disease of the nose is notorious for its high rate of recurrence and vascularity. Potassium Titanyl Phosphate (KTP) laserization of the mass seems to have provided an optimal solution in the management of this disease. We present our experience with the use of KTP-532 laser for this challenging disease.
Zenker's diverticulum, though counnon in western countries is uncommon in India. This diverticuham is an extension of umcosa through Killian's dehiscence. Various surgical methods have been described for the treatment of this condition including the use of lasers but none in Indian Journals. In this paper we describe a case of Zenker's diverticulum where diverticulotomy using KTP532 laser was successfully performed. Its advantages over other techniques are mentioned.
Advances in endoscopy and lasers have improved surgical management of chronic nasolacrimal duct obstruction. This is a preliminary comparison between standard and laser assisted endoscopic dacryocystorhinostomy (DCR).
Combined retrospective and prospective study.
Tertiary referral hospital.
Thirty-eight cases of chronic nasolacrimal duct obstruction underwent endoscopic DCR (26 standard and 12, laser-assisted) and were assessed at 3 and at 6 months postoperatively by nasal endoscopy.
Three months postoperatively (n=38), total relief of epiphora among the nonlaser group was 80.76 vs 75% in the laser group (P=0.982). At 6 months (n=19), the laser group had recorded 100% symptomatic relief compared to 85.71% in the nonlaser group (P=0.964). The laser group suffered fewer complications (33.33 vs 46.15% for nonlaser group).
Lasers show promise in long-term management of duct obstruction and are associated with fewer complications. A larger study is required before and generalization is made.
Oral Submucous Fibrosis is an insidious, chronic disease affecting the oral cavity, sometimes the pharynx and rarely the tongue. 15 patients with Oral Submucous Fibrosis presenting with severe trismus were treated with lysis of the fibrotic bands with a KTP-532 Laser and adjunctive treatment with excellent results over a 12 month follow-up period.
Tendon preservation stapedotomy with or without KTP-532 laser has been performed on 25 rases Jrom November 1998 to February 2000. A study of the symptoms, demographic profile, audiological impairment, surgical treatment and the resultant hearing improvement after 3 weeks and 6 weeks was done. KTP-532 laser assisted cruratamy and stapedotomy was found to be easier than the conventional method. Insertion of the prosthesis was also found to be much easier because of tendon preservation.
A rare case of trichoepithelioma of the external ear is presented Conventional excision with cold instruments is likely to result in excessive bleeding increased post-operative morbidity and scar tissue. This case was treated with KTP/532 laser excision almost bloodlessly with practically no post-operative morbidity and unimimal scar tissue.
Various lateralization procedures have been described in the past to treat bilateral vocal cord paralysis. Though endoscopie lateralization gives good results in terms ofdecannulation rates, the postoperative voice quality is often poor. KTP-532 laser assisted posterior cordotomy was done in 3 cases. This preliminary study showd 100% decannulation rate and good post-operative voice quality. The latter was assessed both subjectively and objectively on VAGMI scales.
Reconstruction of locally advanced oral cancer presents a great challenge to the head and neck surgeon. The main goal of reconstruction is to provide intraoral lining and soft tissue cover. We discuss the use of Bipaddle pectoralis major myoculaneous flap (PMMF) and its modifications for reconstruction of complex oral defects following radical resection.
Retrospective analysis of prospective oral cancer data base.
Tertiary Care Regional Cancer Center.
Three hundred and ten patients were operated for oral carcinoma in this unit between 1993 and 2001. The oral cancer patients who required soft tissue reconstruction for lining and cover were analyzed. Patients in whom bipaddle PMMF were utilised were studied in terms of surgical technique, morbidity, function and cosmetic outcome.
Ninety-one (29.4 %) oral cancer patients required reconstruction for lining as well as cover. Of these, 54 (17.4 %) patients underwent a bipaddle PMMF flap reconstruction. Two horizontal skin islands were used in patients with lateral defects and two vertical islands in patients with central defects. There was no complication in 41 (76%) patients. Complete flap loss was seen in only one patient and differential flap loss in 2 patients (4 %) while seven (13 %) patients had only minor complication. All the patients received post-operative Radiotherapy. Good to average functional and cosmetic outcome was observed in 90% patients.
Bipaddle PMMF offers an effective and leliahle reconstructive option for complex oral defects. By using certain technical modifications, majority of complex oral defects can be managed successfully using a Bipaddle PMMF. In a developing country like India with a large oral cancer disease burden Bipaddle PMMF should he used routinely for complex oral defects in view of its simplicity, versatility and reliability.
Peroral fine needle aspiration cytology (FNAC) was carried out to diagnose parapharyngeal tumors in 67 patients from January 2000 to January 2008. The inflammatory lesions were excluded in the present study. The age of patients ranged from 6 years to 72 years. Analysis of results showed 35 benign tumors and 32 malignant neoplasms. Correlation with histopathology showed a diagnostic accuracy of 92.5% with no false positive report. No complication was encountered in the present study. FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report. Such a large series of parapharyngeal tumors diagnosed by FNAC has hardly been reported in India.
Sixty nine patients with sinonasal symptoms were subjected to diagnostic endoscopy. Functional endoscopic sinus surgery was done subsequently for chronic sinusitis in 42 patients, for ethmoidal polypi in 18 patients and for antrochoanal polypi in 9 patients. A follow up of 18 to 36 months ( mean 27 months) reveals a success rate of 84% in the overall study, 81.5% in patients with chronic sinusitis alone, 87.5% in ethmoidal polypi and 100% in patients with antrochoanal polyps.
This propsective study analyses the role of blink reflex (BR) in 75 patients with Cerebellopontine Angle (CPA) tumours. The aim was to find out the subclinical involvement from the blink reflex findings. Fifth nerve was clinically involved in 82.7% patients while, BR was able to detect afferent abnormality only in 54% patients. The seventh nerve was clinically involved in 74.7% and blink reflex could detect the efferent abnormality is 72% patients. Thus, clinicoelectrophysiological correlation was 56.4% and 72% for V and VII nerve respectively. In the patients in whom there was no V or VII nerve involvement BR showed VII nerve involvement in 12% patients. The subclinical involvement of the V nerve and the brainstem were detected by BR in 4% patients each. In conclusion BR is good test for the assessment of VII nerve function as compared to V nerve function. BR could pick of subclinical involvement in 20% patients.
98% of the patients had improved airway after surgery.All the patients with hyposmia had increased sensitivity to smell following surgery.80% of the patients with asthma and hypertrophied inferior turbinates benefited considerably with surgery as they had marked reduction in the frequency of asthmatic attack.In our study no cases of ozaena had been reported.There were no complications except for 3% of patients with epistaxis and synechiae.Patients with allergic symptoms had significant reduction in their sneezing attacks.8% of the patients reported mild dryness of the nasal cavity after surgery.8% of the patients also noticed not much improvement in their nasal discharge after surgery.
Technetium(99m) ((99m)Tc) Scintigraphy is a well established tool for diagnosing Thyroid disease. The purpose of this study is to evaluate the usage of this particular method in detecting residual thyroid disease after surgery and its role as a diagnostic marker for the work up of a patient with residual disease. All were female patients seen in the ENT OPD for a period of 1 year from Feb 2004-Jan 2005, within the age group 24 yrs to 50 yrs.
The acrofacial dysostosis of nager is a very rare hereditary syndrome in which findings of mandibulofacial dysostosis are associated with defects of the limbs. The developmental defects of the mesoderm if accompany the neurectodermal malformations, result in mental retardation and sensorineural hearing impairment. The conductive type of hearing loss is mostly encountered in Nager's syndrome but here we present a case with sensorineural involvement, along with its analysis of auditory brainstem evoked response audiometry (ABR).
Management of bilateral vocal fold immobility continues to remain a challenge for the Otolaryngologist who attempts to create a balance between creation of an adequate airway and preservation of voice. The flow volume loop obtained by spirometry provides an ideal objective assessment tool to evaluate the results of surgery for this condition. Our experience in using peak inspiratory flow rate (PIFR) and forced inspiratory flow with 50% of vital capacity (FIF(50)) in the lung in assessing the results of surgery is described. Seventeen patients were included in the study. The surgical procedures performed included laser posterior cordectomy with partial arytenoidectomy, endoscopic arytenoidectomy and posterior cordectomy-Kashima's technique. Twelve out of 17 patients were successfully decannulated, a success rate of 70.6%. All patients except one showed an increase in mid-inspiratory flow rates and peak inspiratory flow rates. The mean increase in FIF(50) was 0.44 l/sec (52.6%) and the mean increase in PIFR was 0.41l/sec (39.77%). No statistically significant difference in improvement of inspiratory flow rates was observed between the three surgical procedures used in the study.
Paralysis of the abductors of both vocal cords causes the vocal cords to lie in the midline or paramedian position. This compromises the airways and causes respiratory distress which may often be acute necessitating tracheostomy. A lateralisation of the vocal cord is required to provide adequate airway without significantly affecting speech. Extralaryngeal approach is our preferred approach. This article reports a study of eight cases who underwent arytenoid abduction by an extralaryngeal approach for bilateral abductor paralysis of vocal cords.
To assess the results of endoscopic laser surgery in cases of bilateral abductor palsy on basis of respiration, preservation of voice (phonation) and swallowing.
This retrospective study includes 48 patients (34 males and 14 females) from 5 years to 68 years of age at the time of intervention. 41 cases were operated with subtotal arytenoidectomy and 7 with unilateral posterior cordectomy. 32 patients were operated with tracheostomy and 16 with combination of intuabtion and jet ventilation.
29 out of 32 tracheostomised patients were decannulated (91%). Respiration was adequate for daily routine activities in most of the operated patients. Phonation was normal to near normal in 32 cases out of the operated 34 adult patients (95%). Most of the patients had normal swallowing following surgery.
Subtotal arytenoidectomy with endoscopic laser surgery in cases of bilateral abductor paralysis has established its place as a preferred surgical method to obtain good respiration, phonation and swallowing. It minimizes the surgical time, hospital stay and morbidity.
The use of intratympanic gentamicin is an easily performed office procedure for the conservative treatment of the Meniere's disease patient who has failed medical therapy. The procedure provides excellent control for the symptom of vertigo and is one of the most successful methods in the treatment of vertigo due to inner ear disorders. Surgical ablation is no longer necessary for adequate control of vestibular symptoms and that chemical ablation/alteration may replace the need for surgical vestibular ablation in cases of disabling Meniere's disease and other inner ear causes for peripheral vertigo.
The pyriform sinus fistula is rare congenital anomaly of either third or fourth branchial pouch, which most frequently presented itself by recurrent episodes of neck abscess for long time. Majority of patients with this anomaly presented with symptoms before 10 years and it is more common than has previously been commonly found on leftside (93%). Clinically high index of suspicion, cannulation of the tract under general anaesthesia, Direct laryngoscopy and fistulogram have freequently been successful in identifying the presence of these embryological remnants. Surgical exploration of sinus tract with its total excision, guided with cannula inside its lumen is the definitive treatment.
Parapharyngeal and retropharyngeal abscess as a complication of cholesteatoma is an uncommon entity. We present the unusual case of a 32-year-old man with chronic suppurative otitis media, presenting with parapharyngeal and retropharyngeal abscess. This was treated with incision and drainage of the abscess followed by modified radical mastoidectomy for chronic suppurative otitis media.
This study comprised 32 cases of peritonsillar obscess (PTA)constitutint 0.08% of ENT outdoor cases and 0.80% of indoor admission. Age ranged from 14 years to 58 years(mean 34.21 ± 10.25 SD years). Male predominance was seen in the ratio of 1.69:1. A triad of symptoms comprising pain, fever and peritonillar swelling was seen in 29 (90.62%) cases. Ipsilateral jugulodigastric lymphnode enlargement was the commonest sign present in all the cases. Bacterial culture was positive in 25 (78.12%) cases. Most common aerobic organism isolated was Group A beta hemolytic streptococcus (GABHS) seen on 10 (27.77%) cases. Anaerobic culture could be done in 22 cases only. It was positive in 11 (50%) cases. Commonest isolate was Peptostreptococcus seen in 4 (18.18%) cases.
Congenital cholesteatoma is a rare entity. It may originate at various sites in the temporal bone, for example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or in the external auditory canal. The least common site being the mastoid process. Most common presentation is a retrotympanic pearly white mass with no previous history of ear discharge, perforation or any ear surgery. It can lead to various complications, both intracranial and extracranial, some of which may be life threatening. Bezold's abscess is an extracranial complication which is usually seen in children following acute otitis media with mastoiditis. Here we present a rare case of a 60 year old patient with congenital cholesteatoma complicating to Bezold's abscess. After necessary investigations patient underwent surgery for complete removal of cholesteatoma and the abscess drainage.
Otological intra cranial complications are still a major problem in developing countries. Otogenic brain abscess is a serious, life-threatening complication of otitis media and it usually occurs due to attico antral ear disease. Treatment of otogenic brain abscess is immediate surgical drainage, and mastoidectomy is done to remove the source of infection. This article describes three cases of otogenic brain abscess secondary to attico antral ear disease, which were less than 1.6 cm in size and were treated conservatively with antibiotic therapy. All the patients were started on intravenous antibiotic therapy and serial CT scan was done to monitor the progression of the brain abscess. Canal wall down mastoidectomy was done for the removal of otogenic source of infection. Antibiotic therapy was continued for 6 weeks. Post operative CT scan was done after 8 weeks and it showed complete resolution of the abscess. This study showed that small otogenic brain abscess, which are less than 1.6 cm in size responded to treatment with antibiotics, could be managed by medical therapy. Surgery was required only for the management of attico antral ear disease. To best of our knowledge this is the first review on conservative management of small otogenic brain abscess secondary to attico antral ear disease.
A unique case of congenital choleasteatoma within the mastoid region of the temporal bone is described. The patient presented with a cutane ous fistula into the external auditory canal and epidural abscess. The clinical, radiological, histopathological and operative findings are discussed. A review of the literature shows only one report of a similar case.
Acute retropharyngeal abscess is common in infants and small children due to supuration of retropharyngeal lymph nodes. It is also not uncommon in adults due to injury of posterior pharyngeal wall by sharp object, foreign bodies and instrumentation. But acute retropharyngeal abscess following accidental throttling is reported for unusual etiology.In present study a case of accidental throttling followed by acute retropharyngeal abscess is being reported due to rareness.
Oral manifestation of tuberculosis is uncommon Tongue is the most common oral site of involvement, where the presentations are varied. Here we report a case of primary lingual tuberculosis with an unusual presentation as a cold abscess.
Chronic suppurative otitis media (CSOM) is one of the commonest disease entities encountered in otolaryngology practice. Due to poor economic conditions poor hygiene lack of education and death of knowledge about the disease and its complications, we frequently encounter patients of CSOM with extracranial and intracranial complications. Among the intracranial complications otogenic brain abscess is one of the dreadest. With the improvement of healthcare and accessibility of the poor people to healthcare system and development of CT scan, MRI as diagnostic tools incidence of otogenic brain abscess is becoming less due to early diagnosis and interventions. The objectives of this study are to assess the incidence of brain abscesses to explore age, sex, variation to study clinical presentations and common pathogens responsible.
Branchial fistulae are of congenital origin(6) and consists of skin lined tract opening internally at junction of cartilaginous and bony meatus in case of 1(st) arch anomaly, tonsillar fossa in case of 2(nd) arch, while 3(rd) and 4(th) arch sinuses have internal opening at level of pyriform sinus or below. A complete tract of 3(rd) or 4(th) arch fistulae is yet to be described. Fourth arch fistulae(1) have a distinct clinical pattern of internal opening at pyriform apex, are left sided and associated with suppurative thyroiditis(3), they manifest at a younger age and treatment involves excision of tract with ipsilateral thyroid lobectomy.
To study the presentation, etiology, microbiology and morbidity of deep neck space infections.
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.
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.