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

Inverted Papilloma: experience at Allama Iqbal Medical College and King Edward Medical College

Purpose: In this study, the surgical management of an inverted papilloma of the nose and paranasal sinuses at our institutions [Allama Iqbal Medical College and King Edward Medical College Lahore-Pakistan] is reviewed

Methods: Nine patients diagnosed with an inverted papilloma and treated at the Ear Nose and Throat Departments of Allama Iqbal Medical College and King Edward Medical College Lahore-Pakistan from 1995 to 2003 were retrospectively reviewed. One patient after the complete work up left without surgery. Eight patients were treated with lateral rhinotomy and medial maxillectomy

Results: The patients had a mean follow up of 4 years and eight months [8 years to 2 years 3 months]. The overall recurrence rate was 12%. The patient with recurrence on biopsy showed presence of squamous cell carcinoma

Conclusions: All unilateral nasal masses must be biopsied. Lateral rhinotomy with medial maxillectomy is an effective way of treating sinonasal inverted papilloma in our set up

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

Otitis media with effusion

This study was conducted to analyze the variety of pathological processes leading to OME and to assess the results of different treatment modalities. Patients aged between two years and fifty years with hearing difficulty were included in the study. Study showed that males were 1.72 times more affected than females. Nasal obstruction was an associated symptom in 24[20%] patients. All the patients were subjected to detailed history, thorough clinical otolaryngological examination. Every patient was investigated by pure tone audiometery and tympanometry. A total number of 120 patients were studied. 76[63.3%]were male and 44[36.6%]were females. The mean age was 26 years

Unilateral proptosis: a local experience

This paper presents the experience with unilateral proptosis at Allama Iqbal Medical College [Jinnah Hospital] and King Edward Medical College [Mayo Hospital], Lahore from July 1995 to October 2001. There were 45 patients of unilateral proptosis managed over a period of six years and three months. There was a male predominance with a ratio of 2:1. The age range was 2 - 70 years. The average age was 33 years. The commonest cause was a disease in the ethmoids [27/45 - 60%]. Commonest pathology was chronic ethmoiditis and polyposis [10/45 - 22%]. External ethmoidectomy performed through the Lynch Howarth approach has been the commonest surgical procedure required [20/45 - 44%]. Unilateral proptosis is a multidisciplinary problem and requires collaboration of different specialties

Spread and distribution of cholesteatoma in middle ear cleft

This study comprises fifty cases of chronic suppurative otitis media with cholesteatoma who underwent exploratory mastoidectomy. The main emphasis was to find out the extent and spread of cholesteatoma in and beyond the middle ear cleft. Most of the patients were those with far advanced cholesteatoma involving all parts of middle ear cleft [32 percent] and those with transgression of cleft confines [20 percent]. Cases with cholesteatoma limited to attic area were few [08 percent]

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

Juvenile nasopharyngeal angiofibroma; treatment in 25 patients

The usual clinical behavior of Juvenile nasopharyngeal Angiofibroma is one of locally expanding growth with a potential for intracranial extension. The management of the tumour has raised many important and interesting issues to both the surgeons and radiotherapists. The sophisticated diagnostic techniques, better an aesthetic and operative facilities have reduced the complications associated with this tumour. The surgical approaches for this tumour have evolved over a long period of time. This study includes management of Juvenile nasopharyngeal Angiofibroma in 25 patients where different treatment modalities were offered. Operative procedures giving widest possible exposure for that specific situation are the treatment of choice and radiotherapy is generally reserved for unrespectable lesions

Tuberculosis of the middle ear

Tuberculosis of the middle ear and the mastoid is not a very common condition. Traditionally it has been diagnosed because of its peculiar clinical features such as painless otorrhoea, sensori-neural hearing loss and multiple perforations in the tympanic membrane. We report a case in which there were no clinical features of tuberculosis, otorrhoea was painful and hearing loss was of conductive variety. The final diagnosis depends on histopathology and we recommend pathological examination of all tissue removed during surgery

Prevention in chronic tonsillitis

Tonsillectomy is amongst the most common surgical procedures carried out in children. The diagnosis of chronic tonsillitis is made mainly on history and clinical examination. We intend to document different presentations in this common disease in our part of world and today the indications for the procedure are defined much more precisely

Surface and core flora in recurrent tonsillitis

Recurrent tonsillitis is managed by ENT surgeons quite frequently. Thirty five such patients underwent tonsillectomty and samples were taken from the surface and core of tonsillar tissue and sent for aerobic and anaerobic culture. Results revealed a marked discrepency between surface and core organisms. It was concluded that superficial throat swab has little role to identify all bacteria responsible. Therapeutic recommendations need to be reconsidered on these grounds