Otogenic Intracranial Complications - A Case Series

Background: Intracranial complications of otogenic origin is now a rarity. Advent of antibiotics are both blessings if used intelligently and curse if used indiscriminately especially by quacks. Antibiotic resistance and cross resistance have given adverse results. Methods: A total of twenty cases were studied in the Department of ENT at Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh Results: Maximum number of cases belonged to 10 to 20 years age group, i.e eight cases (40%) followed by six cases (30%) in the age group greater than 30 years, four cases (20%) in 20 to 30 years age group, and 2 cases (10%) below 10 years. Males were affected more than females in the ratio of 4:1. The commonest presenting symptom was otorrhea, headache, fever and hearing loss. About half of the patients had vomiting, some had vertigo, otalgia and one patient had facial weakness. Conclusions: Almost all the intracranial complications encountered were intensively and meticulously treated by medical and surgical exercise which gave excellent results with collective team approach.

TEES - A New Horizon

Background: Transcanal endoscopic ear surgery has many advantages over conventional microscopic ear surgery and is used as adjunct to microscope or is used independently. Precise large visual field and angular vision has edge over the clumsy, expensive, peeping tubular vision of microscopes. Moreover, it is a better teaching methodology for the undergraduates and postgraduates. Our study comprised of twenty-five patients who had safe ear and underwent transcanal endoscopic ear surgery (TEES). Methods: This prospective study was carried out between October 2014 to December 2015 at Hayaat hospital, Allahabad, Uttar Pradesh, India and Hind Institute of Medical Sciences, Safedabad, Barabanki. Twenty-five patients of age group more than fifteen years were selected. All the patients selected had dry and safe type of chronic suppurative otitis media (CSOM). Results: Of the twenty five people ten were females and fifteen males in the ratio of 2:3. All the patients selected had dry ear and safe type of chronic suppurative otitis media (CSOM). All had conductive hearing loss of variable decibels but not greater than fifty-five decibels. Conclusions: Further research is needed in the field of operative TEES. We all need to discuss and more research work is needed to prove its genuinity and practicality.

Tonsillectomy - A Comparative Study of GA or LA

Background: Ethically it is our jurisdiction to decide upon the medical procedure we undertake after weighing the risk benefit ratio. Tonsillectomy is conventionally operated under general anesthesia but it has its own merits and demerits. The aim of the study was to analyse the better procedure. Methods: Hundred patients were operated in the medical college over period of two years in HIMS Barabanki and Govt medical college Kannauj. Seventy patients were operated under general anesthesia and another thirty under local anesthesia. Results: The total operation time, VAS, blood loss, complications, cost effectiveness, bed occupancy, patient turnover rate and patient satisfaction was better in surgical exercise done under local anesthesia when compared to general anesthesia. Conclusions: Tonsillectomy done under local anesthesia definitely has an edge over the general anesthesia.

Esthesioneuroblastoma - A Clinicopathological Study

Background: Esthesioneuroblastoma is a rare tumour accounting for only 3% of all intranasal tumors. Its proximity with important structures and aggressive behavior presents a diagnostic and therapeutic challenge. CT, MRI and histopathology forms the basic pillars of management. Methods: A prospective study was conducted between Feb 1998 to Feb 2004 in the Department of ENT, JNMC, AMU Aligarh. All the five patients taken up for study proved histopathologically to be cases of esthesioneuroblastoma. Results: Of the five patients, three presented with unilateral nasal obstruction (60%) and two with epistaxis (40%). Proptosis was present in one patient. Anosmia, headache and pain were other associated symptoms. Conclusions: hepatic and renal involvement occurs in patients suffering from dengue fever. Hence, multidisciplinary approach should be carried out while treating such patients.

Dentigerous Cyst – Its’ Prevalence and Presentation in a Tertiary Care Teaching Hospital

Background: Dentigerous cyst is although not uncommon but now is infrequently found in otolaryngological practice after the development of dental fraternity. Many times, they are encountered because of swelling in head neck area and facial disfigurement. NCCT and OPG play important role in its diagnosis. Removal can be both open or endoscopically. Methods: This prospective study was carried on n= 5 patients suspected of Dentigerous Cyst were included in our study on the basis of inclusion and exclusion criteria. Results: Here a series of five cases of Dentigerous cyst is presented with discussion regarding clinical and radiological features and treatment with a short review of literature. Conclusions: The Dentigerous cyst are usually encountered in ENT OPD and needs to be properly investigated. Advent of endoscopes and knowledge of anatomy of the area gives edge to the Otorhinolaryngologist over dentist in its management.

Diphtheria Resurgence – A Prospective Study in a Tertiary Care Teaching Hospital

Background: Diphtheria was one of the six killer diseases of childhood and was presumed to have been controlled if not eradicated through immunization programme. Emergence of diphtheria once again has challenged our health policies, immunization and public awareness campaign. Stringent measures need to be taken lest the disease is blown out of proportion and control measures fail. Hence, to highlight the resurgence of diphtheria, its repercussion, mitigation activities under taken by the government we have undertaken to pen down this paper. Methods: This prospective study was carried on n= 5  patients included in our study on the basis of inclusion and exclusion criteria. Results: Our approach to the diphtheritic patient should be multifaceted and thorough examination and investigation is required by team approach to counter the impact of the toxins released as it starts with Otorhinolaryngological manifestations and terminates with the cardiovascular and neurological complications.  Conclusions: Three major measures are indicated to counter the resurgence of diphtheria i.e. high immunization coverage of target groups, prompt diagnosis and management of diphtheria cases, and rapid identification of close contacts with their effective management to prevent secondary cases.

Oral approaches for benign lesions- a novel approach.

Introduction -Cosmetically acceptable surgical results are the demand of this modern era. Aesthetic facial look has lots of impact on financial, social and personnel life. Material and Methods- A total of twenty cases were studied in the Department of ENT at Hind Institute of Medical Sciences (HIMS), Barabanki, Uttar Pradesh. FNAC, USG and CECT were done and only benign lesions were selected which could be approached intraorally. Results-There were 20 patients aged between fifteen years to sixty years. There were ten cases of submandibular swellings, four cases of sebaceous cyst, three cases of lipoma and two cases of parapharyngeal space swelling and one case of plunging ranula. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Conclusions-The innovative surgical approaches were studied and meticulous, cosmetically acceptable results which were highly appreciated by the patients and their attendants were achieved. The stay in the hospital and complication rates were also quite low in intraoral approach than conventional external approach. Hence, intraoral approaches should be used for benign lesions which are amenable to surgery.