A Clinical Study of Deep Neck Abscesses

Background: Deep neck space infection is common clinical entity seen in ENT practice. Early diagnosis and adequate treatment can help in reducing the morbidity and mortality associated with the disease. Methods: This study was conducted in the department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu for a period of 2 years w. e.f August 2017 to August 2019. 50 patients presenting with symptoms of throat pain, dysphagia, odynophagia, fever, neck swelling, trismus, halitosis and change in voice were included. Only clinically and radiologically confirmed cases of deep neck space infections of all age groups and both the sexes were included in the study. Needle aspiration or incision and drainage was done at the earliest stage in majority of patients. Pus was sent for culture and sensitivity analysis. All the patients were started on antibiotics, supportive therapy in the form of intravenous fluids, analgesics, antipyretics, mouthwashes were given. Results: Out of 50 patients, highest incidence was noted in 31-40 years age group accounting for 24% patients with male: female ratio of 1.27: 1. In the present study the most common presenting complaint was painful swallowing (odynophagia) seen in 48(96%) patients followed by fever seen in 46(92%) patients, trismus, pain throat, neck swelling, neck pain, difficulty in breathing., dental pain, bad breath. The most common cause was dental infection in 24(48%) patients followed by salivary gland infection in 11(22%) patients, recurrent tonsillitis was seen in 9(18%) patients. The most common infection was ludwig’s angina seen in 28 patients (56%) patients followed by peritonsillar abscess seen in 10(20%) patients. Conclusion: Since most of the infections are dental in origin, patient education regarding oral and dental hygiene needs to be stressed

A Clinicopathological Study of Cervical Lymphadenopathy

Background: The aim is to know gender wise development and morphological variation of the frontal sinus in the pediatric age group of Gurugram district of Haryana. The development and pneumatisation of the frontal sinus is the predictor of skeletal growth pattern. The craniofacial structures grow proportionately with the normal development of the body structures. Methods: In this prospective study, a total of 36 subjects were studied. The study was conducted in the Department of Radiodiagnosis of SGT Medical College, Budhera (Gurugram) Haryana from January 2019 to March 2019. This included 12 females and 24 males falling in the age group of 8-18 years. The frontal sinuses were evaluated on various morphological features. Plain X-Ray of paranasal sinus was evaluated by Caldwell’s view. The sinuses were evaluated for width, height, number of scallops, septations and supraorbital cells. Results: Average width and height of left frontal sinuses were 23.8 mm with the range of 5.5 – 43 mm and 28.4 mm with the range of 13-45 mm respectively. Average width and height of right frontal sinuses were 20.4 mm with the range of 9.8 – 39 mm and 20 mm with the range of 13-38 mm respectively. The average number of scalloping on right and left were 1.9 and 2.19 respectively. The septations were noticed in 13 (36.11%) on left and in 16 (44.44%) on right side. Supraorbital cells were found in 16 (44.44%) on left side and 17 (47.22%) on right side. Conclusion: There is a lot of variation in the appearance and development of the frontal sinus in pediatric age group. The dimensions had been found smaller on right side as compared to left side. Scalloping and supraorbital cells had been found more on right side than on the left side. Septations were more on left side as compared to right side.

A Clinical Study of Nasal Bone Fractures: A Retrospective Study

Background: As the most prominent position organ is the face, nose is the most affected location in this trauma and it ispossible to compare the nasal trauma etiology separately with that of the facial trauma.Materials and Methods: This hospital-based retrospective study was conducted in the Department of ENT, SMGS Hospital,Jammu, from August 2016 to September 2019. The records of patients with nasal fracture diagnosis were retrospectivelyevaluated. The diagnosis was based on the clinical history, physical examination, and nasal bones radiography. Clinicalassessment of patient included inspection of the face, paying attention to the presence of any swelling, and/or deviation of thenasal axis. Then, nasal cavity is examined with anterior rhinoscopy for septal hematoma and/or fracture, and presence and/orlocation of epistaxis. Moreover, the nasal dorsum is palpated to detect any sign of crepitation. The presence of crepitation,radiologic findings, swelling, septal hematoma/fracture, and causes of trauma was all documented.Results: The mean age was 23 ± 3 years. The male-to-female ratio was 2.12:1. The frequently affected age group was21–30 years constituting 44% of total cases. The most common clinical finding was nasal crepitation seen in 100 (80%) patients,followed by epistaxis (76.8%), swelling of dorsum (70.4%), laceration of skin (32%), and septal hematoma (9.6%). The mostcommon cause was aggression seen in 40 (32%) patients followed by road traffic accidents (28.8%). The correlation betweennasal crepitus, swelling of nasal dorsum, and septal hematoma was found statistically significant (P < 0.05).Conclusion: Men in the 2nd and 3rd decades are more affected by nasal bone fractures (NBFs). X-ray nasal bones along withfindings such as nasal crepitations, swelling of nasal dorsum, and septal hematoma are strongly suggestive of NBFs.

Otitis Media with Effusion in Children with Hearing Loss- A Hospital Based Retrospective Study

Otitis media with effusion is a salient disease and its clinical symptoms are not so obvious to be noticed by parents or even doctors. Therefore early diagnosis and treatment are important as hearing deprivation in children can have effect on linguistic development of child. Methods: This retrospective study was conducted on children with hearing loss aged between 3-15 years presenting to ENT OPD of SMGS Hospital, for a period of 1 year from. Total of 100 children were included. Detailed history aand complete ENT examination was done. PTA and Impendance Audiometry was done. Results: The mean age was 7 years with male: female ratio of 1.8: 1. Hearing loss which was the chief complaint. Other complaints were aural fullness (38%) followed by otalgia (29%), poor attention (17%) and poor acaedemic performance(16%).Higher prevalence in males(59%) of OME as compared to females. About 30% patients showed congested drum suggestive of acute suppurative otitis media. Other findings noted were dull drum (20%), air bubbles (6%) and air fluid level (8%) all were suggestive of otitis media with effusion.. Pure tone audiometry revealed moderate hearing loss in 59% patients of otitis media with effusion whereas it was mild in 14 patients.Impedance audiometry revealed B type graph in 85% patients. Conclusion: To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms of otitis media with effusion.

Clinicopathological Study of Cancer Larynx

Background: In India, laryngeal cancer contributes to approximately 3–6% of all cancers in men.Objective: The aim of this study was to study the clinicopathology of cancer larynx with respect to age, sex, site, complaints,histology, staging, and predisposing factors.Materials and Methods: The study population consisted of 100 patients who were suffering from cancer larynx. A completeclinical history was taken from the patients. After the clinical diagnosis of growth larynx, the patients were prepared for directlaryngoscopy under general or local anesthesia. The lesions were visualized, the extent of growth defined, and biopsy taken andthen sent for histopathological examination. The staging of cancer larynx was done according to tumor, node, and metastasisclassification.Results: There were 80 male (80%) and 20 female (20%) patients. Maximum patients were in the age group of 51–60 years(40%). 54% showed supraglottic cancer, 45% had glottic cancer, and only 1% had subglottic cancer. In cases of supraglotticcancer, the most common complaint was difficulty in swallowing seen in all 54 patients; in cases of glottis cancer, the mostcommon complaint was hoarseness of voice seen in 88.88%. There was only 1 patient of subglottic cancer who presentedwith difficulty in swallowing and difficulty in breathing. Out of 100 cases, there were 99 cases of squamous cell carcinomawhereas there was only 1 case of adenocarcinoma. Out of total 100 patients, overall most common stage was Stage 2 (34%),followed by Stage 3 (25%), Stage 4a (16%), Stage 1 (15%), and Stage 4b (10%). Smoking was found to be the most commonpredisposing factor (92%), followed by alcohol intake (78%) and tobacco chewing (50%).Conclusion: Early diagnosis and treatment of laryngeal cancer is important to reduce the morbidity and mortality of patients.

Pattern of Occurrence of Primary Head and Neck Cancers in Jammu City- A Hospital Based Study

Background: Head and neck cancers (HNCs) are a major form of cancers in India. The spectrum varies from place to place within the country because of significant diversified risk factors. Unfortunately, despite an increase in medical knowledge, survival rates of head and neck cancers have not been observed to improve greatly. This is true, especially in tumors located in obscure primary sites or late presentation. Methods: This is a retrospective study on patients with histologically confirmed diagnosis of head and neck cancer between May 2016 and July 2018 at department of ENT and Head and Neck Surgery, SMGS Hospital, Jammu. The histopathological diagnoses were analysed with respect to age, gender, addiction habits, site of tumor and statistical analysis was done. Results: A total of 425 cases were analysed. There were 399 males and 26 females with M: F ratio of 15:1. More than 97% patients were Squamous cell carcinoma. Maximum incidence (>60%) was in 40-60 years age group. Difference in incidence in males and females was significant in each age group (p<0.05). In patients of age <40 years oral cancers were common whereas in >40 years cancers of oropharynx and larynx were common. Tobacco smoking was a most prevalent risk factor for carcinoma oropharynx, larynx, and hypopharynx. Tobacco chewing was a most prevalent risk factor in females, young males, and carcinoma buccal mucosa patients. Alcohol consumption alone was observed in <1% patient as a risk factor. In oral tongue cancer, smoking and tobacco chewing were equally prevalent. Habit of tobacco chewing and alcohol were significantly higher in carcinoma buccal mucosa than other HNC suggesting synergistic effect specific to this site. Conclusion: Increased populace awareness programs emphasizing the preventable factors associated with this cancer and change in life style will decrease morbidity and mortality associated with late stage presentation.

Pattern of Abnormal Findings in Adult with Nasal Obstruction on Rhinoscopy and Nasal Endoscopy.

Nasal obstruction is one of the most distressing symptom of nasal and sinus disease.The nasal obstruction may be unilateral or bilateral or is intermittent ,progressive or persistent.The routine anterior and posterior rhinoscopy gives very little information as we can see the structure which lie directly in the line of sight and moreover the posterior rhinoscopy may not be possible in some cases.As a result , the early diagnosis of some unpleasant lesions remained elusive without nasal endoscopy. In addition , the diagnostic nasal endoscopy helps us in precise photodocumentation of pre- and post treatment finding ,which is unsurpassed for teaching .This study , thus , strongly recommend thorough endoscopic examination of nose and postnasal space especially when anterior and posterior rhinoscopy fail to reveal the cause of nasal obstruction.

Neurilemmomas of Parapharyngeal Space

Neurilemmomas are rare neurogenic tulnours. Their parapharyngeal location is uncommon. Three patients of neurilemmomas of this location are described. Different modes of presentation, radiological findings and management of these cases are discussed.

Neurilemmoma of Parotid.

An unusal case of neurilemmoma of parotid gland arising in a 14 year old boy is reported. The preselltation was a painless mass and the facial nerve functions were intact. Peroperatively tumour did not have any relation with facial nerve. Fine needle aspiration cytology could give a clue towards neurogen ic nature of the tumour.