Tonsillar fossa steroid injection for reduction of the post-tonsillectomy pain.

Fifty patients (26 males and 24 females) who underwent tonsillectomy were then treated with injection of the long acting steroid (Kenacort-A) into the right tonsillar fossa after the operation. The left side was used as the control. Post-operative pain was assesed by the patients and was graded and recorded daily as mild, moderate, and severe pain on both sides of the throat for 2 weeks. A significant reduction of pain in the tested side (right side) was noted in the majority of the patients. The duration of pain was shorter in the right side than the left side. It seemed to significantly reduce the post-tonsillectomy pain. Because of its simplicity, cost effectiveness, and no complications, the technique should be used for pain-free tonsillectomy in non-contraindicated cases.

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report.

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

Upper aerodigestive tract burn: a case report of firework injury.

The case of a 46 year-old German man with upper aerodigestive burn by firework was reported. He presented with the symptoms and signs of upper airway obstruction. Tracheostomy was done and direct laryngoscopy with microscopic examination revealed swelling and denudation of the mucosa of the oral cavity and supraglottic area. Intravenous steroids and antibiotics were administrated for treatment. It is suggested that proper management needs an understanding of the mechanism and effect of the corrosive agent. Careful airway management resulted in a good outcome in this patient.

A non-comparative trial of the efficacy and safety of fexofenadine for treatment of perennial allergic rhinitis.

An open-label, non-comparative study was performed in three Otolaryngology centers in Bangkok, Thailand, to assess the efficacy, safety and tolerability of fexofenadine in Thai patients with perennial allergic rhinitis. Altogether 101 perennial allergic rhinitis patients were included, 33 males and 68 females. Mean age was 33 years, average duration of symptoms was 6 years. All patients received fexofenadine hydrochloride 120 mg once daily (OD) in the morning for 2 weeks. Patients recorded their allergy symptoms daily using a 5 point rating scales in the diary card. At the end of 2 weeks, patients and investigators assessed the overall efficacy of treatment. Adverse events and onset of symptom relief were also recorded by every patient. Blood test and ECG were performed before and after treatment in one center (Siriraj Hospital). Total symptom scores and nasal scores decreased significantly from a baseline at 1 week and 2 weeks after treatment (p < 0.05). The mean onset of symptom relief was 2 hours and 12 minutes. The global assessment of the treatment by patients and investigators showed significant concordance. There was no significant change in either the vital signs, laboratory tests or ECG. The incidence of treatment related adverse events was 8% but all were mild and easily tolerated. Drowsiness was reported from only one patient. This study suggests that fexofenadine 120 mg once daily was an effective, safe and well tolerated treatment for perennial allergic rhinitis in Thai patients.

Lingual osseous choristoma: report of three cases.

Osseous choristoma represents the dense, mature, bony tissue in an abnormal location. We reported three cases of lingual osseous choristoma, herein, a year after the report of eight cases in 1998. All three lesions were at or close to the foramen caecum. The lesions were smooth, round or lobulated and pedunculated in shape and stony hard in consistency. All of them were preoperatively diagnosed, based on the above unique clinical findings without any radiography. The lesions were simply excised without local recurrence.

Comparison of ofloxacin otic solution with oral amoxycillin plus chloramphenicol ear drop in treatment of chronic suppurative otitis media with acute exacerbation.

The efficacy and safety of 0.3 per cent Ofloxacin otic solution (OFLX) 6 drops twice daily was compared with those of oral Amoxycillin 500 mg three times daily plus 1 per cent Chloramphenicol ear drop at 3 drops three times daily (AMOX + CRP) in a two-week treatment of chronic suppurative otitis media (CSOM) with acute exacerbation. 80 adult patients were enrolled in a prospective, randomized, investigator-blind study at the outpatient ENT service of Chulalongkorn University Hospital. The most common pathogens isolated at the pretreatment visit were Staphylococcus aureus (30.3%) and Pseudomonas aeruginosa (24.7%). The susceptibility of all the pathogenic isolates to ofloxacin, amoxycillin and chloramphenicol were 96.4, 57.1 and 51.8 per cent respectively. The overall response expressed as an improvement or cure of otalgia, otorrhea and middle ear mucosal inflammation was recorded. It revealed that the improvement rate of the OFLX-treated patients was better than that of AMOX + CRP-treated, but was not statistically significant. However, the cure rate was significantly better in OFLX-treated than in AMOX + CRP-treated groups in terms of painless (p = 0.05) and dry (p < 0.001) ears. Ototoxicity was assessed by an elevation in bone conduction threshold (BC) and/or speech reception threshold (SRT) of greater than 5 dB or a presence of high tone hearing loss resulting from treatments. A significant decrease in BC and SRT was revealed in OFLX-treated ears (p < 0.0001; p = 0.002 respectively) but a significant elevation of BC was found in AMOX + CRP-treated ears (p = 0.007). The ototoxic rate was significantly higher in AMOX + CRP-treated than in OFLX-treated ears whether assessed by BC (p < 0.001) or SRT (p = 0.03). In conclusion, OFLX was more effective and safer than AMOX + CRP in the treatment of CSOM with acute exacerbation.

Myringoplasty: a simple procedure for out-patients.

The standard treatment of tympanic membrane perforation is myringoplasty. We describe a new myringoplasty technique requiring only a partial removal of skin on the ear drum remnant followed by lateral placing of fascia and free skin graft. The overall cure rate in our series is 97 per cent. The hearing gains for the overall cases are 13.9 dB (p < 0.001) for the AC, 13.6 dB (p < 0.001) for the air bone gap closure, 13.1 dB (p < 0.001) for the SRT and 4.2 per cent (p = 0.005) for the SDS. Minor complications are observed in only 14 per cent. Our technique is simple, effective and can be performed on an out-patient basis.

Severe epistaxis from rhinosporidiosis: a case report.

Rhinosporidiosis is quite rare in Thailand, but the actual incidence may be higher than the numbers reflect. This is thought to be due to misdiagnosis by physicians who are unfamiliar with this disease entity or physicians who found a case but did not describe its presence. The authors report a case in a 17 year old male with the lesion involving both nasal cavities, nasopharynx and left maxillary sinus presenting with severe epistaxis, which was treated by complete surgical removal with electric cauterization of its base. We warn physicians who face this problem to be aware of this disease entity.

Malignant transformation in a benign encapsulated schwannoma of retropharyngeal space: a case report.

Malignant schwannomas are rare in the head and neck, however benign schwannoma of this area are common. Cases of malignant schwannoma have been reported in the nasal cavity, paranasal sinuses, eye, parapharyngeal space and neck with or without an association of von Recklinghausen disease. We described a case of an asymptomatic solitary malignant schwannoma arising in the retropharyngeal space which was treated by local excision and postoperative radiotherapy. To our knowledge, this case may be the first reported case in the world literature.

Microsatellite instability in Epstein-Barr virus associated with nasopharyngeal carcinoma.

The result reported here represents the first human genomic screen for MSI in Epstein-Barr-Virus associated NPC. The analysis revealed the incidence of MSI only 1 of 23 cases (4%) which indicates that MSI is less common in NPC development.

Loss of heterozygosity for chromosome 11 in Epstein-Barr-virus associated nasopharyngeal carcinoma.

In order to demonstrate and define possible tumor suppressor gene loci on chromosome 11 associated with NPC, we used 7 STR to test for LOH on 25 NPC samples. LOH was detected in 46 per cent of cases. Most LOH loci were clustered on the long arm. Further study demonstrated 22 per cent and 45.5 per cent of cases with LOH on 11q13 and 11q23 respectively.

Homograft myringoplasty-controlled button technique: a preliminary report.

The successful outcome of homograft myringoplasty in small and medium perforation of the tympanic membrane was only 44.12 per cent. A better result was obtained in the small perforations (59.10%) compared with the medium ones (16.77%). We conclude that the procedure should be appropriate for repairing the incomplete healing of the tympanic membrane following standard tympanoplasty and removal of the tympanostomy tube. Furthermore this procedure is simple, safe, cost-effective and can be done in the out-patient department.

Treatment of tonsillar crypt infection with CO2 laser: a preliminary report.

The treatment of tonsillar crypt infection by CO2 laser vaporization of the crypt and tonsillar tissue is safe, effective and cost effective. The procedure requires short operative time without any risk from general anesthesia and can be performed on out-patient basis. We advise the procedure as an alternative option to treat tonsillar crypt infection instead of standard tonsillectomy, but further studies should be carried out.

The treatment of chronic suppurative otitis media and otitis externa with 0.3 per cent ofloxacin otic solution: a clinico-microbiological study.

.3 per cent ofloxacin solution has been studied widely and has been proved to be safe in both animal and human studies. Ototoxicity and hair cell damage were not found in animal experiments. Ototopical treatment in both pediatric and adult patients was proved to be safe in previous studies. P. aeruginosa and S. aureus play the major role in both CSOM and OE, and most causative pathogens are susceptible to ofloxacin. This study showed that the use of 0.3 per cent ofloxacin otic solution was safe in both children and adults and yielded excellent clinical results.

Eosinophilic lymphofollicular hyperplasia with eosinophilia: report of cases.

Two patients with lesions involving the parotid and submandibular region are presented. Clinical pictures and microscopic findings were suggestive of Kimura's disease with coexistent parasitic infestation. Possible parasitic etiological factors were discussed without confirmation.