Management of oesophageal foreign bodies

The aim of the study was to evaluate the management of foreign bodies in the oesophagus and to determine the association with socioeconomic status. This cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose. The average age of the patients was 10.38 years; 29 cases [85.2%] were in children under 12 years. There were 18 females [52.9%] and 16 males [47.1%]. Thirty patients [88%] presented with a history of dysphagia, and 25 [73.6%] had vomiting. The site of impaction was the post-cricoid region in 22 patients [66%], the lower oesophagus in 5 [15%], the mid-oesophagus in 4 [13%], the posterior pharyngeal wall in 1 [3%] and the pyriform fossa in 1 patient [3%]. Coins were the most common foreign body [61.8%]. Socioeconomic analysis showed that 18 patients [52.9%] were in the low socioeconomic class, 12 [35.3%] in the middle class and 4 [11.8%] in the upper class. The presence of a foreign body in the oesophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families

Aspergillus infection of paranasal sinuses

Aspergillus sinusitis is not an uncommon disease in our part of the world. There is still no consensus on classification of the disease and treatment methods have also not been standardized as yet. We assessed clinical characterization of the pattern of the disease in this clinical study. A total of 23 consecutive patients undergoing external ethmoidectomy for suspected fungal sinusitis were selected for the study. All patients included in the study were immunocompetent. Caseous material obtained following surgery was sent for microscopy with Potassium Hydroxide [KOH] and histopathological examination to know type of the fungus and nature of the disease. The average age of the patients was 27.7 years [SD 40 +/- 30]. They ranged in age from 10 to 70 years. There were 17 [73.91%] male and 6 [26.09%] female patients in this study. M: F ratio was 1:0.35. In 19 [82.61%] of 23 patients, Aspergillus species was found on microscopy and histopathological examination. Non-invasive disease revealed in 13 [56.52%] and invasive in 6 [26.09] patients. In 4 [17.39%] patients, simple inflammatory polyps were seen. For all practical purposes, Aspergillus infection of paranasal sinuses can be broadly divided into two categories, non-invasive Aspergillus sinusitis that usually presents as fungus balls or caseous material without fungal tissue invasion and invasive Aspergillus sinusitis with presence of septate hyphae in the soft tissue. The final specimen obtained during surgery should be submitted for histopathological examination to detect invasion of the tissues as this has effects on further treatment of disease

Airway foreign bodies

Objectives: The objective of this study is to review the management of foreign body inhalation, the type of foreign bodies commonly inhaled, the site of impaction and the complications related with it

Design of Study: Retrospective clinical study

Setting: Mayo Hospital Lahore, ENT Unit I

Period: April 1999 to September 2000 [18 months]

Materials and methods: 32 consecutive patients with suspected foreign body inhalation were included in this study. A total of 35 bronchoscopies were carried out in these 32 patients. The patient data was collected on the basis of management complications and follow-up

Results: Total number of cases was 32 including 24 males [75%] and 8 females [25%]. Age range of the patients was 6 months to 30 years [average 6.65 years]. Most commonly inhaled foreign bodies were plastic whistles in 19 cases [66]]. The most common site of impaction was right main bronchus [62%] followed by left main bronchus [24%x]. Complications occurred in 2 patients [7%]

Conclusions: Foreign body in the airway is a common problem affecting young children mainly. The most common foreign body inhaled is a whistle. It is a preventable problem and educating the parents, teachers and other childcare providers in this regard is highly desirable

Tracheostomy - a life saving procedure

We analyzed 50 patients requiring tracheostomy over a two year period. Stridor and respiratory distress were the most common presentation in these patients. The indications of tracheostomy were varied and consisted of carcinoma of larynx in 16 patients, laryngo-tracheobronchitis and diphtheria in 8 patients each, tetanus in 6 patients, epiglottises and respiratory papillomatosis in 4 patients each. Three patients had neck trauma and one patient had bilateral vocal cord paralysis. Complications of the procedure included dislodgement of the tube, crusting, wound infection, surgical emphysema and minor haemorrhage. Serious complications like cardiac arrest and pneumothorax were seen in one patient each. Tracheostomy is a common procedure and saves many lives

Rhabdomyosarcoma of the nose and paranasal sinuses

Rhabdomyosarcomas are the common malignant soft tissue neoplasms in children but they are rare in nose and paranasal sinuses in adults. We report a case of Rhabdomyosarcoma in ethmoid sinus in a 65 year old male and review the literature