International Journal of Otorhinolaryngology and Head and Neck Surgery

Role of GeneXpert in diagnosis of rifampicin resistant tuberculosis in patients with cervical lymphadenopathy

2022-11-20T18:39:04+00:00

Tuberculosis is one of the most common causes for cervical lymphadenopathy apart from distant metastasis and lymphoma. Early diagnosis of this disease reduces the patient’s morbidity by initiating early course of Antitubercular treatment with complete resolution of disease. Hence, for diagnosis of this condition we are searching for a modality which can give results in shorter period of time, which is more sensitive, specific and most important easier to perform. Gene Xpert is one such modality which fits into these criteria. In our case series, we are aiming to study the role of Gene Xpert in diagnosis of rifampicin resistant tuberculosis in patients with cervical lymphadenopathy. In our study, excisional biopsy from cervical region was done in 30 cases and were sent for acid fast bacilli culture, Ziehl Neelsen staining and GeneXpert studies, histopathological examination and results were analyzed.

Ear, nose and throat disorders found in diabetic patients

2022-12-25T22:38:42+00:00

Background: Diabetes, a non-communicable metabolic disease in perfect growth in the world, poses a problem of neurovascular dysfunction in the inner ear and the secondary immunodeficiency it causes gives a particular character to the clinical course of certain diseases of the ear, nose and throat (ENT) organs. Objective were to find out the prevalence of otorhinolaryngological disorders in patients with diabetes mellitus who presented themselves to the endocrinology and ENT departments of the Mali hospital, the diabetes center and the district hospital IV Bamako (Mali).

Methods: The patients of the various departments concerned in our study, all benefited from screening consultations, we collected the data: socio-demographic, clinical and paraclinical, the management of the ENT disease and the ongoing treatment of diabetes.

Results: ENT pathologies represented 2.08% of consultations of diabetic patients with a female predominance. The 46-55 age group represented 39.53%. Diabetes was type 2 in 91% of cases and fasting hyperglycemia was found in 65.12% of patients. Auditory neuropathy, influenzae rhinitis, otitis media were the common ENT diseases found in type 2 diabetics and in patients with a blood glucose greater than 1.80 gm/l.

Conclusions: Diabetes, a non-communicable metabolic disease in perfect growth in the world, causes a problem of neurovascular dysfunction in the inner ear and the secondary immunodeficiency it causes gives a particular character to the clinical course of certain disorders of the ENT organs. Auditory neuropathy, influenzae rhinitis, otitis media were the common ENT diseases found in type 2 diabetics.

Could tympanometric volume be a useful tool to predict the success of type I tympanoplasty in simple chronic otitis media

2023-01-04T06:25:12+00:00

Background: Middle ear aeration level is an important precursor of chronic otitis media (COM) and one predictive factor for tympanoplasty success. Tympanometry measures the volume of the external ear canal, middle ear cavity, aditus, and mastoid air cells in patients with tympanic membrane (TM) perforation. The aim of the study was to determine whether the pre-operative tympanometric volume and the interaural tympanometric volume differences in unilateral simple COM can predict the success of type I tympanoplasty.

Methods: Retrospective analysis of type I tympanoplasties performed in adults between January 2017 and December 2020 in a tertiary hospital. Bilateral COM, revision surgery and tympanoplasty using cartilage grafts or associated with other procedures were excluded. Success was defined as no evidence of TM perforation on otoscopic examination and tympanogram, at least six months after surgery.

Results: Sixty-one patients were evaluated. The mean age was 43 years old, and there was a female predominance (55.7%). The overall success rate was 77%. Location or size of perforation weren’t different among patients with and without surgical success. We found a statistically significant result (p=0.009) regarding interaural tympanometric volume differences, with a median of 2.7 ml (IQR 3.6) in the surgical success group and a median of 1.3 ml (IQR 1.26) in the recurrence group. 90.6% of patients with interaural tympanometric volume difference greater than 2 ml had successful surgery.

Conclusions: A good aeration of middle ear, demonstrated by higher interaural tympanometric volume differences, can predict success of type I tympanoplasty.

Infectious and noninfectious epiglottitis in adults: our experience

2022-12-29T07:48:34+00:00

Background: The present prospective study was conducted in the department of ENT at GMC Doda for a period of three years from February 2019 to March 2022. The study aimed at evaluating the causes, presentation and management of adult epiglottitis.

Methods: The patients presenting with the sign and symptoms of epiglottitis were evaluated and were subjected to rigid/flexible endoscopic examination. Patients presenting with respiratory distress were categorized as per Freidman’s classification.

Results: Epiglottitis was seen in 21 patients with 13 male and 8 female patients. The age distribution was between 26 and 68 years (mean, 44.4±11.3). Infection, as a cause of epiglottitis was present in 14 subjects and 7 patients had non infectiousetiology. Corrosive ingestion (HCL) and angioedema was seen in two patients each. Hot water aspiration, hot milk and foreign body aspiration (fish bone) was present in the rest of three patients each. Most common complaint of patients in our study was sore throat followed by painful swallowing and voice change.

Conclusions: Epiglottitis in adults can be easily overlooked because of its non-specific presentation. Importance needs to be stressed upon the examination of larynx in patients presenting with sore throat not responding to conventional treatment or with symptoms of respiratory distress and voice change. Airway management should be take preference in patients having stridor before embarking on laryngeal examination with close Follow up.

Effect of medical treatment on eradication of biofilms in chronic rhinosinusitis

2022-12-14T05:53:20+00:00

Background: Long-term macrolides and intranasal corticosteroids have evidence-based recommendations. It has been reported that macrolide therapy caused objective and subjective improvements which correlated to the duration of therapy. Topical nasal steroids are the mainstay of treatment in CRS. It is proposed that intranasal steroid may increase the restoration of normal epithelium.

Methods: Sample size of 24 in each group is sufficient to detect the difference between positivity rate with 80% power and 5% level of significance clinically diagnosed cases of CRS with nasal polyps in age group of 18-60 years were taken. Outcome was measured with multiple scoring systems like SNOT-20, CT scoring, endoscopic scoring system.

Results: Significant improvement was seen in the SNOT-20 scores with p value of 0.011 and endoscopic scores with p value of 0.001 in group having macrolides along with steroids pre-operatively however the scores post-surgery didn’t show any significant change in both groups. The efficacy of macrolide with nasal steroidal spray or nasal spray alone showed no further benefit in the subjective outcome measures post operatively. Also, no statistically significant eradication of biofilms or decrease in density could be appreciated in both groups. Furthermore, there was no significant difference in recurrence rate.

Conclusions: Our result demonstrated the subjective improvement in patients of macrolide group post treatment which could be attributed to its anti-inflammatory effect. Even though macrolides in combination with nasal spray reflected some improvement in the secondary outcomes but the primary outcome of eradication of biofilms couldn’t be achieved.

Deep neck space infections: a study of 20 cases

2022-10-18T09:54:43+00:00

Background: Deep neck space infections is defined as infection in the potential spaces and fascial planes of the neck. Deep location and complexity of these spaces make diagnosis and treatment difficult. Proper diagnosis and immediate treatment is necessary to attain cure without any complications. Treatment principally comprises of airway management, surgical intervention i. e.; incision and drainage of the abscess and appropriate antibiotic treatment as per culture and sensitivity report.

Methods: Present study was performed from June 2015 to June 2016 and comprised of 20 cases. All patients coming to the OPD of tertiary care centre with suspected deep neck space infections. The demographic characteristics, presenting symptoms, etiology, imaging and treatment of each case was reviewed.

Results: We evaluated 20 patients with deep neck space infections. The mean age was found to be 40 years. Diabetes was found to be a co-morbid condition in 25% of the patients. Male: female ratio was 1:1.5. In the majority of cases, the etiological factor was found to be odontogenic infections (50%). Streptococcus pyogenes was the organism which was most commonly isolated. Ludwig’s angina was the most common clinical presentation (20%).

Conclusions: Deep neck space infection is a life-threatening condition in diabetics, immune-compromised and elderly patients. Odontogenic infections were the most common etiology for deep neck space infections. There is need to establish secure airway before initiating surgical intervention. The widespread use of antibiotics has decreased the incidence of deep neck space infections, but remains a fairly common problem.

A retrospective comparative study of postoperative bleeding after coblation tonsillectomy versus noncoblation tonsillectomy in North Indian population

2022-12-17T02:41:30+00:00

Background: This study was done to look at the difference in incidence of postoperative bleeding after tonsillectomy using coblation or noncoblation.

Methods: A review of all the cases of tonsillectomy done at NIMS Medical college from January 2019 to September 2022 was done to ascertain type of tonsillectomy performed and the presence of postoperative bleeding. Statistical analysis was done by chi-square test to determine a statistical difference between the postoperative bleeding rate of coblation and noncoblation method. The Cochraine-Armitage test of linear trend was done to measure change in the postoperative bleeds. The tested term was divided into two-month durations, and the coblation postoperative bleeds were checked for every 2-month period.

Results: 238 tonsillectomies were performed. The postoperative bleed rate for noncoblation tonsillectomy was 3.4% (8/238) and 5/238 (2.1%) in coblation tonsillectomy. No statistical difference (p=0.93) was found between bleed rates for coblation versus noncoblation techniques. There was no difference seen in the need for operative intervention to control postoperative bleeding: 8 (5.4% of only non coblated patients and 3.4% of all tonsillectomy patients) for noncoblation procedure and 5 (5.6% of only coblated patients and 2.1% of all tonsillectomy patients) for coblation procedures (p=0.25). Postoperative bleed rates in coblation patients for the 2-month periods did not reveal an increasing or decreasing trend in the bleed rate (p=0.49).

Conclusions: Coblation tonsillectomy is a safe method for performing tonsillar surgery with no significant difference in postoperative bleeding from previous techniques and no increased need for operative intervention to control postoperative bleeding.

Expression and clinical significance of IL-6 in patients with allergic rhinitis

2022-12-26T06:42:33+00:00

Background: Allergic rhinitis is a chronic inflammatory disease with a high incidence affecting the quality of life of patients. The objective of the study was to explore the expression and clinical significance of IL-6 in patients with allergic rhinitis.

Methods: This cross-sectional analytical study was conducted in the department of ENT, H&NS, Government Medical College, Srinagar. A total of 180 patients were included in the study, out of them 90 patients with allergic rhinitis were cases and 90 patients comprised the control group who did not have allergic rhinitis. The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA).

Results: A total of 184 patients participated in the study. The mean age in case group was 35.7±15.46 years compared to control group which was 37.1±12.89 years. There was male dominance in both the groups. Comparison of IL-6 levels as per severity of allergic rhinitis was assessed in this study and it was found that in patients with severe allergic rhinitis the mean IL-6 levels were 65.2±5.32; in moderate, patients had IL-6 levels of 52.8±5.84 and in mild patients had IL-6 levels of 46.7±6.81.

Conclusions: Clinical testing of IL-6 is likely to improve the diagnostic rate of early allergic rhinitis and help in halting the progression of disease and improve the patients prognosis and reduce symptoms and morbidity. Higher the levels of IL^_6 more severe will be the allergic rhinitis.

Mortality, morbidity and sequelae of COVID-associated mucormycosis; 18 months follow up study

2022-12-06T03:07:48+00:00

Background: The second wave of the COVID-19 pandemic in India was associated with an increased incidence of rhino-orbital-cerebral mucormycosis. The objective of this paper was to prospectively explore the epidemiology, management, and results of 18 months follow-up of patients presenting with COVID associated mucormycosis at a tertiary referral centre in India.

Methods: Patients presenting with symptoms suggestive of COVID-associated mucormycosis over two months were included in the study. Patients were staged based on the extent of the disease. Surgery was the primary modality of treatment except in those with intracranial spread, altered sensorium, and poor prognosis. A combination of liposomal amphotericin B and posaconazole was used as adjunct medical treatment. Patients were followed up and outcomes at one year of treatment were recorded.

Results: Out of a total of 26 patients who were diagnosed with COVID associated mucormycosis, 21 patients underwent bimodality treatment (medical and surgical). The extent of surgery was based on the stage of the disease. Six eyes received retrobulbar injections of Amphotericin B to salvage vision. The overall mortality was 38.46% and 23.8% in those where the intent of treatment was curative. At the end of one year, 16 of 21 operated patients survived with mild to severe sequelae.

Conclusions: Mucormycosis is a deadly fungal infection with high mortality. Early diagnosis and prompt, aggressive treatment is paramount in preventing mortality. A multidisciplinary approach is useful for effective management. Continuous follow up is paramount to identifying and treating complications.

Laryngeal cancer presenting similarly as laryngeal tuberculosis: a near missed diagnosis

2022-12-26T01:16:35+00:00

Tuberculosis (TB) and malignancy are global threats and have claimed millions of lives worldwide. TB is a preventable and curable disease prevalent in developing countries. It is well known to be a diagnostic chameleon and often mimic malignancy. Laryngeal TB is an extremely rare form of TB and has many similarities to laryngeal carcinoma. This case report highlights the importance of diagnostic biopsy in a 57-year-old gentleman with characteristic presenting features of laryngeal TB that is persistent hoarseness and haemoptysis. He was investigated and treated for pulmonary TB however his laryngoscopy biopsy revealed to be laryngeal carcinoma. Based on this case report, it is shown that malignancy could have easily been missed had a presumptive diagnosis of laryngeal TB been made initially. Nevertheless, when evaluating dysphonia in a patient, while it is important to consider laryngeal carcinoma, laryngeal TB must also not be overlooked as possibility, especially in endemic areas.

Bilateral diffuse temporal bone osteoradionecrosis: a diagnostic and therapeutic challenge

2023-01-12T13:20:50+00:00

Temporal bone osteoradionecrosis (TBORN) is a rare complication of head and neck radiotherapy. It usually presents as a unilateral disorder with a long latency between the exposition to radiation and the symptoms onset, which might overlap with other clinical entities, making it difficult to establish the diagnosis. It can be classified as localized, when confined to the tympanic bone; or diffuse, when extended to other portions of the temporal bone, with the inherent implication in treatment selection and prognosis. The authors present a case of a 53 years old patient with multiple comorbidities, including an immunosuppressive state, who presented an infected massive diffuse TBORN bilaterally. The diagnosis was challenging and the patient was initially treated for a malignant otitis externa, but after established diagnosis of TBORN, the patient was treated resorting to surgery, topical treatment and hyperbaric oxygenotherapy, with consequent symptoms resolution. This case illustrates the difficulty in establishing the diagnosing and treatment of TBORN and highlights the importance of a low suspicion threshold for this rare complication of radiotherapy, for which there is still no consensus regarding the best treatment.

A rare cause of esophageal stricture: undifferentiated carcinoma of the lower esophagus

2022-12-05T01:04:50+00:00

Undifferentiated carcinoma of the esophagus (UEC) is an uncommon esophageal malignancy. Patient with UEC has a notably poor prognosis because of extensive metastasis despite at the early stage. A standard treatment regimen for UEC has not yet been established. We reported a case of undifferentiated carcinoma in a 46 years old male with a common chief complaint of progressive dysphagia accompanied by chest discomfort after meal and significant weight loss. Base on the history of illness, physical examination, imaging, and histopathology we concluded that the patient was diagnosed with UEC at the gastroesophageal junction. The patient the received chemoradiotherapy of CDDP + 5-FU along with radiation, but declined the temporary gastrostomy as nutritional intervention. Esophageal undifferentiated carcinomas are rare neoplasms and often associated with locoregional recurrence and/or distant metastasis. Multidisciplinary involvement for the treatment of this disease is necessary to obtain a better outcome.

Chondroblastoma- a rare sinonasal tumor: case report and review of literature

2022-12-13T11:31:42+00:00

Chondroblastoma is a benign primary bone tumor that typically develops in the epiphyses of long bones. Chondroblastoma of the craniofacial skeleton is extremely rare, with most cases occurring in the squamosal portion of the temporal bone. In this report, we describe a case of chondroblastoma of the nasal cavity presenting with a left sided nasal mass which was excised with open approach. We review the literature on craniofacial chondroblastomas with particular emphasis on sinonasal lesions.

When tracheotomy was the only resort in paediatric tracheo-bronchial foreign body: case report

2022-11-21T01:05:01+00:00

The pediatric individual is likely to present with an aspirated foreign body that maybe oriented as such that it may necessitate often an alternate route for removal. Rigid bronchoscopy with jet ventilation is the intervention undertaken at the earliest. In wide caliber foreign bodies a different approach has to be adopted. Tracheotomy, thoracotomy, bronchotomy and pneumonectomy are the next level procedures. A cervical tracheostomy had to be undertaken in a child with a week old impacted conical tail cap of a ball point pen.

Labium superius oris mucormycosis: an enigma

2022-11-23T09:17:43+00:00

Mucormycosis is an aggressive opportunistic fungal infection affecting immunocompromised patients. It has six manifestations: rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated and localized infection. However, isolated mucormycosis of upper lip (labium superius oris) without any bony invasion has not been reported in literature to the best of our knowledge. Hence this poses a diagnostic challenge. A 50-year-old male came with left sided nasal pain and left sided nasal obstruction associated with very mild uniform swelling of upper lip of 24 months duration. He underwent FESS in a local hospital and was misdiagnosed as granulomatous origin probably Tuberculosis. Even on ATT the symptoms didn’t subside and hence presented to our hospital. On incisional biopsy deep fungal infection probably mucor was reported and he was put on tab Posaconazole 300 mg OD. On recurrent upper lip swelling, excision biopsy was done. HPE was reported as fibrocollagenous stroma interspersed by multiple non-caseating epitheloid granulomas with plenty of foreign body type of giant cells. PAS showed broad aseptate acute angled hyphal forms suggestive of mucor. The follow up clinical presentation of the patient was very satisfactory with complete regression of upper lip swelling and no damage to surrounding structures. The case report highlights the existence of localized form of mucormycosis without bony necrosis in immunocompetent patients which require minimal surgical intervention along with oral medical therapy rather than extensive debridement.