Measurement of laryngeal dimensions in neonates.

Intimate knowledge of laryngeal anatomy and various laryngeal dimensions is crucial for successful airway management. Selection of a proper endotracheal tube is also a critical factor. Subglottic dimension is the most important measurement of larynx because of it being the narrowest part of the infant larynx. Data about various infantile laryngeal dimensions in Indian population is sparse. In this article, we present various laryngeal dimensions using 30 infantile laryngeal autopsy specimens and review of literature.

Incidence of hearing impairment among rural and urban school going children: a survey.

A total of 1,670 school going children (urban 1030 and rural 640) in the age range of 12-14 years were screened for hearing loss during a survey conducted by the Department of Otolaryngology of the Postgraduate Institute of Medical Education & Research, Chandigarh. 6.31% of cases in the urban group were found to be having hearing loss as compared to 32.81% of cases in the rural group. Secretory otitis media was found to be the commonest cause of hearing impairment in both the urban and rural group accounting for 5.33% and 33.59% respectively.

Schwannoma of infratemporal fossa in a young child.

Schwannomas in children are rare. A nine-year-old boy presented with swelling right side of face and proptosis for 4 months. CT scan showed a heterogenous mass in the right infratemporal fossa and extending to the posterior ethmoid. There was erosion of the bony walls of the infratemporal fossa. A biopsy through the sublabial approach was reported as schwannoma. The tumour was approached by Weber-Ferguson approach and excised in toto with complete relief of symptoms.

Fibreoptic assessment of post intubation laryngotracheal injuries.

The use of endotracheal intubation for respiratory support of critically ill patients has become a standard life saving form of therapy. Most complications of intubation become apparent only after extubation which may manifest in the early or late post extubation period. This study was undertaken to demonstrate the occurrence and extent of laryngotracheal injuries in intubated patients by performing flexible fibreoptic bronchoscopy at varying intervals following extubation. It was found that initial laryngoscopy findings were more pronounced in patients intubated for upto twelve days. Furthermore, it was also observed that the initial laryngeal pathology seen on fibreoptic laryngoscopy was not an accurate predictor for the development of adverse post extubation sequelae. Maxillary sinusitis developed significantly in patients intubated nasally. Routine flexible fibreoptic examination of the larynx following extubation is recommended for early detection of granulomas, synechia of vocal cords and vocal cord immobility to prevent troublesome sequelae.

Rhabdomyosarcoma of head and neck--an analysis of 24 cases.

Clinical records of 24 cases or rhabdomyosarcoma involving head and neck region were studied. Majority of the patients (83.3%) were under five years of age. The common sites of involvement were the middle ear (50%) and the nasopharynx (17%). Embryonal variety was noted in majority of patients (83.3%). Pain and swelling in the post aural or pre-auricular region was the commonest mode of presentation. Last four cranial nerves were involved in eight patients and four patients had extension of the tumor in the posterior cranial fossa. Twenty patients having embryonal rhabdomyosarcoma received combination of chemotherapy and radiotherapy. Half of these remained tumor free upto six months. Surgical extirpation was done only in two patients, where the disease was localised. The tumor in these two patients was of pleomorphic variety and did not recur till two years after surgery.

Auditory profile in children recovering from bacterial meningitis.

In the present study BERA profile of 30 post-meningitic children was compared with 15 normal children of the same age and it was observed that 36.6% children in the age range of 6 months to 36 months were found to have varying degree of sensorineural deafness. Severe bilateral sensorineural hearing loss (> 80 dB) was observed in 6.6% children and moderate (40-80 dB) hearing loss in 30% of children. Abnormalities were bilateral in both the samples of children with severe hearing loss (> 80 dB) whereas among 9 children who had moderate hearing loss abnormalities were bilateral in one patient and unilateral in the remaining 8 children. A relationship between higher incidence of sensorineural deafness and younger age of children, and occurrence of seizures during meningitis were noted. But no relationship was observed with either sex, hydrocephalus, subdural effusion or with low CSF sugar and high CSF proteins.

Brain stem electric response audiometry in neonates with hyperbilirubinemia.

Auditory evoked responses using BERA were studied in 30 newborn babies with plasma bilirubin > or = 15 mgm/dl and repeated after treatment of neonatal jaundice with bilirubin levels of < or = 10 mgm/dl. A few jaundiced babies (16.5%) showed absent BERA response at the initial/subsequent examination. After treatment, 3/30 babies showed absent wave form responses and 2 of these were clinically kernicteric. Jaundiced babies had prolonged wave peak latencies and inter peak latencies. Treated babies showed a tendency towards recovery in their BERA responses which were however not complete. Total plasma bilirubin value at the time of BERA examination and mean maximal bilirubin values had no correlation with the incidence and degree of BERA abnormalities.

A clinical and radiological study of maxillary antrum in lepromatous leprosy.

Seventy consecutive patients having multibacillary leprosy were questioned about symptoms of nasal involvement and sinusitis. Complete otorhinolaryngeal examination was carried out in all these patients and they were subjected to radiographic examination of paranasal sinuses. Radiological abnormality of maxillary antrum was found in 40 (57%) patients. Radiological changes were unilateral in 25 and bilateral in 15 patients. Localised or generalised mucosal thickening was the most common finding, followed by diffuse opacity. The development of radiological changes in maxillary antrum correlated with high bacterial density (BI 3+ and above), nasal deformity, and disease duration of more than two years.

Evaluation of a deaf child.

One should be aware that the measurement of hearing is really an evaluation of a child's behavioural responses in a controlled setting to the presentation of various acoustic stimuli. The determination of hearing loss in some children is an ongoing process and may require more than one test session. Difficult to test children should be evaluated with as many techniques as possible for accurate cross checking of test results. Flexibility, patience and understanding and persistence are the watch words of successful hearing testing with children. For the bulk of patients who require audiological assessment however, the test battery (BOA, IMPEDANCE & BSER) approach seems to be the best available present day approach coupled with long term follow ups and careful management.

Effect of instant preparation of betel nut (pan masala) on the oral mucosa of albino rats.

Paste made out of an instant betel nut preparation was painted into the oral cavity of 21 albino rats on alternate days for a period of six months. Biopsies were taken from the oral mucosa at the beginning of the study and every two months there after and compared histopathologically with those obtained from a control group of 14 albino rats. Mild to moderate loss of nuclear polarity and increase in keratoses, parakeratoses, inflammatory cell infiltration and vascularity were noted when compared to the control group. The increase in mitotic figures was statistically insignificant and no definite changes in pigmentation or atypical cells were seen. These findings suggest the possibility of mild leukoplakia. Submucosal collagen increased steeply and steadily throughout the study period and at the end of six months, 88.23 per cent of biopsies showed thickened and condensed sub-mucosal collagen, indicating submucous fibrosis.

Post laryngectomy complications and their mode of management--an analysis of 203 cases.

Two hundred and three laryngectomized patients have been evaluated for the possible causes of post operative complications. 58 out of 203 patients (28.5%) developed pharyngocutaneous fistula. Wound infection was present in 57 cases (28%). Two patients had flap necrosis and 12 patients developed dysphagia after surgery due to pharyngeal stenosis. The possible causes attributed to high occurrence of pharyngocutaneous fistula are, advanced nature of disease, preoperative radio therapy and wound sepsis. Prior to 1980, the incidence of pharyngocutaneous fistula in our series (Arora et al. 1983) was 41.6 percent. But it decreased to 13.7 percent between January 1981 to June 1987. The important factors which led to the decreased incidence of pharyngocutaneous fistula were thought to be the change of suture material for pharyngeal repair from chromic catgut to Vicryl, use of vacuum suction as a replacement of corrugated rubber drain and aseptic syringe drainage and postoperative coverage with broad spectrum antibiotics.

Involvement of palate and cheek in leprosy.

22 Cases of bacillary positive leprosy with no apparent lesion in the oral cavity, soft or hard palate were studied for any evidence of pathological involvement. Granulomata were present in 11 (65%) out of 17 cheek biopsies studied. M. leprae were identified in four specimens only. 9 specimens (64%) out of 14 palate biopsies showed definite granulomata. M. leprae were seen in six specimens.

Eighth nerve evaluation in leprosy.

25 cases of bacillary positive leprosy patients and 25 age and sex matched controls were investigated for assessment of cochleo-vestibular status. Impaired hearing was complained of by 4 patients. None had tinnitus, dizziness or vertigo. On testing 44% patients were found to have unilateral or bilateral perceptive deafness. Specialised tests of hearing indicated that the deafness was of cochlear type. The vestibular functions were not affected. Leprosy seems to selectively involve the cochlea.