Bony complications of chronic sinusitis

To study bony complications of sinonasal disease and its varied manifestations. In this five year retrospective study, cases with bony complications from 2003 to 2007 were collected and their records evaluated. Twenty cases were identified with bony complications. Maxilla was most common bone affected. Five patients were diagnosed as having acute osteomyetitis [35%]; an equal number were diagnosed as having chronic osteomyelitis of which one had a fistula on the cheek and one had fistula due to tuberculosis. Odontogenic infections and chronic sinusitis each gave rise to two cases with osteomyelitis of the palate and maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in two cases, one of which had a discharging fistula in left frontoethmoid region displacing eye. Fungal sinusitis led to destruction of lamina papyracea. Acute osteomyelitis responded to antibiotics. Polymicrobial infection is common, antibiotics are indicated initially. Surgery is considered when an abscess is revealed by CT and if it deteriorates clinically. Results suggest that FESS is effective for diagnosis and treatment of complications but can be combined with conventional surgery which is effective in management of refractory sinusitis

Deafness and depression

Late diagnosis, late intervention, inconsistent follow-ups, inadequate maintenance of hearing aids and not so good outcome is something nobody amongst service providers in the field of ENT, audiology and also psychiatry wishes to come across. The fact that many factors, elements, people and physicians are involved in the equation of service provision and results / outcome, therefore, it is very difficult to predict or contemplate what one does will bring good results. The element of myth, physicians dealing with deafness rarely getting help from psychiatrists and psychologists. The age at diagnosis is one of the key element in this process. It marks the beginning of a long term process and is therefore considered a parameter of concern. With a view to determine seriously how we take the hearing problem. This study was conducted at Lahore Medical and Dental College, Ghurki Trust Teaching Hospital. The objective was to find the mean age of diagnosis, type and amount of deafness, associated problems with emphasis on related psychiatric problems in particular the element of depression. In a total of 200 patients between the ages of 10 years and 80 years over a period of five years from Jan 2003 to Jan 2008 were evaluated and investigated. They represent the major ethnic group of central Punjab. Every patient underwent a detailed clinical examination, any depressive or psychiatric symptoms and relevant audiological investigations. The cause of hearing loss could be found in 82% cases. Main causes were infections [31%], trauma [19%], presbyacusis [8%] and genetic [5%]. The cause of hearing loss could not be established in 18% cases. It was higher in males [58%] than females but noticeably higher in uneducated muslim patients. Late diagnosis was also related to financial background, family size and accessibility to the health facility. In conclusion the findings of the study are a cause for concern because the element of psychiatric disturbances was very high [60%] and it raises the questions about the importance the patients with hearing problems. It is also to be pointful out that and how little importance clinicians give to associated psychiatric disturbance, in particular depressive episodes

Use of microdebrider in endoscopic nasal polypectomy- a comparison with simple endoscopic polypectomy

To compare the use of microdebrider in nasal polypectomy with the endoscopic removal of the nasal polyps using the forceps. A comparative descriptive study. The Department of ENT and Head and Neck Surgery, Sir Ganga Ram Hospital, Lahore from 10-10-1999 to 10-05-2001. All the diagnosed coses of sinunasal polyposis who required surgical intervention from both the gender and age group more than 13 years. A Performa including all details of pre-operative endoscopic assessment, operative details and post-operative follow-up findings was designed. All patients had bilateral Nasal Polyps and underwent bilateral Intranasal Polypectomy using microdebrider on Right side and forceps on Left side. All these procedures were performed endoscopically using camera and monitor display. The microdebrider allows timely and "on-line" removal of blood and tissue, keeping the operation site clean so that the surgery can proceed safely and smoothly under conditions of good visibility. In the post-operative follow-up period the complications like crusting, discharge, adhesions, reoccurrence of disease and stenosis of maxillary sinus ostium were found to be much less frequently or not at all by using the microdebrider in comparison with endoscopic nasal polypectomy with forceps. The use of microdebrider in nasal polypectomy has the advantage of complete clearance of disease and less per-operative as well as post-operative complications in comparison with nasal polypectomy using forceps under endoscopic guidance

Langerhan's cell histiocytosis presenting as bilateral bleeding nasal polypi

Langerhan's cell histiocytosis is a rare clinical entity. Cases have been described in medical literature affecting head and neck region. In this first reported case, a 40 years old male presented with recurrent epistaxis. On examination he had bilateral bleeding nasal polypi originating from the lateral nasal wall in the middle meatus region, proceeding backward towards the nasopharynx as well as anteriorly, filling the nasal cavity completely with bilateral submandibular lymphadenopathy: Diagnosis was made on histopatohlogy and using special immunohistochemical stains [S-100 positive]. Surgical curettage, steroids, cytotoxic chemotherapy and low dose radiotherapy, 7x2 Gy in 4 fractions to the head and neck region achieved local control of the disease fairly rapidly