This is a case series of 100 patients with deep neck spaces infections, to study its etiology, clinical course, morbidity and mortality. The study was conducted over 5 years and emphasised on the importance of early diagnosis and management of deep neck space infections. This entity is still one of the major health hazard in the field of modern otolaryngology because of their potentially devastating complications as well as the new challenges posed by AIDS epidemic and the resurgence of tuberculosis.
Introduction: Parapharyngeal space tumors are rare, they represent only 0.5% of head and neck tumors. Among these tumors, Pleomorphic adenoma of salivary gland is the most benign tumor particularly developed in depends of the deep lobe of Parotid gland. This clinical observation allows us to describe a specific case of parapharyngeal tumor developed in depends of accessory salivary glands. Observation: We report the observation of a 43 years old patient without a specific pathological history which was diagnosed with a rare parapharyngeal tumor, the Pleomorphic adenoma developed in depends of accessory salivary glands. While doing a review of the literature we are discussing means of diagnosis and treatment of this affection. Conclusion: Parapharyngeal tumors are rare, they still raise the problem of precocity of their diagnosis and the most suitable surgical procedure
The laryngeal mask airway (LMA) provides an excellent intermediate airway for select patients. It has been shown to be safe in many procedures involving the head and neck. However, there have been several reports of complications associated with either the positioning of the LMA or cuff pressure including lingual nerve injury, hypoglossal nerve injury, tongue swelling, and recurrent laryngeal nerve injury. We present a case in which the LMA cuff was mistaken for a neck mass in a patient undergoing open neck biopsy of a level II lymph node. In this report we review existing case reports as well as the mechanism by which the LMA may distort the pharynx and lateral neck. We recommend that in cases in which dissection extends into the lateral neck adjacent to the pharynx that an alternate airway be considered.
AOM is a common clinical condition encountered in the pediatric emergency department. The diagnosis of AOM is based on symptoms of fever, otalgia and/or any or all of the following signs such as erythema, bulging, fluid behind tymphanic membrane, having limited or absent mobility of tymphanic membrane, and finally otorrhea. Unnecessary antibiotics use leads to antibiotic resistance among causes of otitis media. Decision-making in giving or avoiding antibiotics has been controversial. Watchfulwaiting has been advocated in recent years for the treatment of uncomplicated AOM in children older than 2 years.
Aims: A study was conducted to study the various factors affecting the habilitation outcome in children with severe to profound hearing loss. Materials and methods: The study was conducted at Command Hospital (Eastern Command), Kolkata over a period of two years. It was a pilot study including 25 pre-lingually deaf children, aged between 0-14 years, randomly selected, of both sexes, with severe to profound bilateral hearing loss. All children with associated co-morbidities like neurological disorders or multiple medical problems were excluded from the study. We formulated a novel scoring system. The initial evaluation was done on a total score of 14 followed by detailed evaluation of the children, initiation of amplification and speech and language therapy. Follow up was done at 3, 6, 9 and 12 months respectively. During each follow up, they were evaluated on a total score of 17. The results were analyzed statistically. P-values of less than 0.05 were considered significant. Results: All the factors appeared to play a cumulative role in the final habilitation outcome, with the results being statistically significant. The most important factor appeared to be the type and degree of amplification used. Our unique scoring system also showed promise to evolve into a tool to assess prognosis of children following intervention based on their initial evaluation scores Conclusion: Our results clearly point out the importance of universal neonatal hearing screening, early diagnosis and earliest possible adequate intervention fortified by parental care & training by skilled audiologists.
Introduction: Vagal cervical shwannomas are relatively rare tumors in the literature. We report through this clinical case, our recent experience in the support of this pathology. Objectives: To point out possible misdiagnosis of imaging and therapeutic difficulties during treatment. Study: vagal cervical shwannomas generally present in the form of a lateral-cervical isolated mass, asymptomatic, and have a very slow evolution. Their positive diagnosis is based on imaging (CT, MRI) and their certainty diagnosis on the histological examination of surgical resection piece. However radiological interpretation errors are frequent in the literature, causing the discovery of these tumors during the operation. The treatment of the shwannoma is essentially surgical. Conclusion: Need for a team trained in cervical and nerve surgeries for adequate support for these cervical shwannomas.
CASE 1: This is a 41 year old female who presented with the 5th episode of right sided Bells palsy with a past history of several previous episodes of the same separated by several months interval. Patient was treated with a taper dose of Prednisone and acyclovir followed by valcyclovir, with full recovery in 3 weeks. Medical history was significant for recurrent shingles and no history of trauma. Family history was suggestive of recurrent Bells palsy on her maternal side, namely her mother, maternal uncle and cousin. The combined number of episodes for the family was 8, with an �age of first episoderanging from 24 to 70. CASE 2:
Introduction Functional endoscopic sinus surgery (FESS) is a well-established strategy for management of sinus disease following failure of maximal medical therapy. Preoperative optimisation and postoperative care have impact on the ultimate outcome. However, at present, there is lack of evidence and guideline in terms of the optimal peri-operative care. Objective The aim of this study is to survey the peri-operative management protocols currently used by Otolaryngologists in Singapore and to compare the differences in management between patients with chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and recurrent nasal polyps (NP). Methods Questionnaire survey was performed to collect data regarding pre-operative medications, post-operative nasal packing practices as well as post-operative medications. Results Questionnaires were sent to a total of 90 Otolaryngologists registered under the Singapore Medical Council and 25 Otolaryngology registrars. We received a response rate of 61%(70/115). Preoperatively, chronic rhinosinusitis patients received oral steroids less often than those who underwent primary FESS(p<0.001) and revision FESS(p<0.001) for nasal polyposis. Preoperative oral antibiotics(59%) were commonly prescribed in all groups of patients. Postoperatively, chronic rhinosinusitis patients received oral steroids less often than those who underwent primary FESS(p<0.001) and revision FESS(p<0.001) for nasal polyposis. Although there is a trend towards the use of nasal packing with infusion for primary FESS and revision FESS for nasal polyposis compared to chronic rhinosinusitis, this was not statistically significant.The infusion agent of choice was triamcinolone
Schwannoma or neurinoma (coined by Verocay in 1910) is an ectodermal benign tumor arising from Schwann’s cells. Although this tumor is widely distributed in head and neck, especially in association with acoustic or eighth cranial nerve. They are rarely seen in parotid region. Balleet. al. reported only two cases among 142 cases of parotid tumors seen over 6 years. Very few originate from facial nerve and in majority of these cases they arise from its intratemporal branch .Preoperative diagnosis of neurilemmoma is difficult. Fine needle aspiration cytology although has high specificity for parotid swellings, has a limited value in diagnosis of neurilemmoma in parotid region, as was seen in our case. Hence this case is been reported due to rarity of these tumors in this region.
Foreign body in paediatric airway is a potentially life threatening situation, which requires emergency endoscopic removal. The removal of foreign body presents considerable problems, both to the endoscopist and the anesthesiologist. It is a challenging procedure for the anesthesiologist to maintain airway for adequate ventilation and oxygenation in patients whose pulmonary gas exchange is already compromised. We report a case of eighteen month old child who aspirated lump of coal while playing and was managed by emergency bronchoscopy.
Introduction: Angiectatic nasal polyps are a rare and distinct type of inflammatory sinonasal polyp, which can clinically and radiologically mimic a sinonasal neoplasm. We describe a unique case of an angiectatic nasal polyp in an 80 year old lady presenting with recurrent epistaxis and radiological features suggestive of an inverted papilloma. Management: Initial biopsies proved inconclusive. Complete resection was performed through an endoscopic medial maxillectomy approach based on the suspicion of an inverted papilloma. Initially, the histopathology was reported as an inflammatory polyp but this was subsequently revised to an angiectatic nasal polyp. Histopathology Findings: A well-defined polyp with stromal degenerative hyaline change, stromal haemorrhage and telangiectasia, lined by flattened surface epithelium. Conclusion: Angiectatic nasal polyps are a rare pathological entity and as such can cause a significant diagnostic dilemma as illustrated in this case. Therefore, an awareness of different clinical presentations and distinct histopathological features is important in establishing an early definitive diagnosis. Furthermore, there is little precedent in the literature to guide management in such a case, and we therefore consider this report to be noteworthy and instructive in this respect.
Scrub typhus usually presents as pyrexia with or without multiple organ involvement. Acute hearing loss occurs in about one third of cases and is a useful clue toward the diagnosis. We present two cases of scrub typhus with acute reversible hearing loss from an endemic area. The diagnosis was confirmed by nested PCR.
Epistaxis remains a common ENT emergency. Current evidence varies on whether a seasonal variation exists with the incidence of epistaxis. This review of epistaxis admissions in East Kent aimed to ascertain if indeed any relationship exists between epistaxis and any particular seasons or temperature. Methods: This was a retrospective review of all epistaxis admissions in the East Kent Hospitals NHS Trust (covering Ashford, Canterbury, Margate and surrounding Thanet) over a 5 year period: 2005 – 2009 inclusive. A total of 1,102 patients with epistaxis severe enough to require hospital admission were included in the study. The number of admissions were divided into the seasons: Winter (December – February), Spring (March – May), Summer (June – August) and Autumn (September – November). Epistaxis frequencies per year were also correlated with data on minimum and average monthly temperatures for the region supplied by the Meteorological Office UK. Results: Epistaxis admissions were highest in winter and lowest in summer. Winter 320 (29.04%), Spring 311 (28.22%), Summer 217 (19.69%) & Autumn 254 (23.05%). The parametric one way ANOVA and non-parametric Kruskal-Wallis tests demonstrated a statistically significant correlation between the seasons and epistaxis admissions; p<.05. Epistaxis admissions also correlated with mean monthly temperatures with an increase in admissions noted in cold temperatures (<10 degrees Celsius) p<.05. Conclusion: This study shows an increase in epistaxis admissions in winter months and correlation with monthly temperatures. This finding is corroborated by similar studies in the UK and Europe. A possible explanation is the effect of indoor heating during winter on increasing nasal mucosal dryness. Further studies are required to confirm this seasonal variation as this can inform workforce planning for epistaxis management.
Auditory Neuropathy coexisting with bilateral conductive hearing loss has not been reported so far .This case report highlights how the underlying Auditory Neuropathy can be unmasked by Speech Audiometry and that subsequently changes the entire management.Unlike Pure Tone Audiometry (PTA), Speech Audiometry is not necessarily done always for all patients, especially in developing countries and we highlight the need for it to be used routinely. CASE REPORTA 13 year old girl presented with complaints of bilateral hearing loss for one year.Her symptoms were slowly progressive, particularly the difficulty in understanding speech.She had associated bilateral tinnitus but there was no history of vertigo or ataxia, headaches, vomiting, loss of consciousness or seizures.Her birth and early development were normal and there was no past history of jaundice or familial hearing loss.The patient's two siblings were normal and her parents were distantly related.
Purpose: Extramedullary plasmacytoma (EMP) is a rare neoplasm of plasma cell origin. Although the head and neck is the most common location of EMP, there are only a handful of cases reported in the nasopharynx. Design: Case report and review of the literature Results: A 50 year-old healthy male presented with a year-long history of increasing bilateral nasal congestion unresponsive to medical therapy. Nasal endoscopy revealed a large exophytic mass filling both posterior nasal cavities. Imaging demonstrated a 3X3 cm mass arising from the nasopharynx and extending into the posterior nasal cavities bilaterally. A biopsy was performed, demonstrating extramedullary plasmacytoma. The patient underwent surgical debulking followed by radiation therapy to the primary site and bilateral necks. He has not recurred to date. Conclusions: Although surgery is usually considered second line treatment for EMP of the head and neck, this case demonstrates the utility of surgical debulking in symptom palliation before definitive treatment with radiation.
Extramedullary Plasmacytomas(EMP) are rare tumors accounting for 0.4% of all head and neck malignancies and 4% of all nonepithelial tumors of nasal cavity.The absence of multiple myeloma must be confirmed with bone marrow examination and skeletal surveys, before arriving at a diagnosis of EMP.We report a case of extramedullary plasmacytoma of the nasal cavity in a 60 year old female, who was a chronic tobacco sniffer.The case demonstrates the multidisciplinary approach required for the optimal diagnosis and management of such tumors and proposes chronic irritation of the nasal mucosa as one of the etiological factors for EMP.
