ABSTRACT
INTRODUCTION: Labyrinthine fistulae (LF) are the common complications of chronic otitis media (COM) of squamosal variety. The final therapeutic outcome of this condition is to preserve the cochlear and vestibular functions. Herein, we present the data of the cases managed at our institute with respect to their presenting complaints, adopted therapeutic approaches and outcomes. MATERIALS AND METHODS: A retrospective chart review was conducted on all cases with COM squamosal type in adult patients. A total of 275 patients were reviewed, out of whom 30 cases had LF. The results were mainly studied with respect to the postoperative improvement of hearing and vertigo. RESULTS: The incidence rate of LF in the present study was obtained at 10.9%. Only 50% of the cases had the symptoms of vertigo. Furthermore, positive fistula test was elicited in 3.3% of the cases. All cases undergoing preoperative imaging were diagnosed successfully. In addition, 42.85% of the cases had profound hearing loss preoperatively, which sustained after the operation. However, 47.61% of the cases showed an improvement of at least ≥ 10 dB in the air-bone gap. Out of the 15 LF cases with vertigo as the main complaint, only 11 cases referred for follow-up. In this regard, 63.63% of the cases had no postoperative vertigo symptoms. CONCLUSION: Patients with LF may not have complaints of vertigo and a positive fistula sign upon admission. Pre-operative imaging facilitates the diagnosis of this condition. The removal of the matrix under constant irrigation, followed by repair with bone wax and/or autologous tissue, is sufficient to preserve the cochlear and vestibular symptoms postoperatively.
ABSTRACT
INTRODUCTION: Laryngopharyngeal reflux (LPR) is considered an important cause of voice disorder. We aimed to determine the frequency of LPR in patients with voice disorder and the association between Koufman Reflux Symptom Index (RSI), Reflux Finding Score (RFS), gastroesophageal reflux disease (GERD), and proximal acid reflux in these patients. MATERIALS AND METHODS: We performed a prospective study in patients aged more than 18 years presenting at the ear, nose, and throat (ENT) clinic with a change in voice lasting more than 3 weeks. All patients underwent nasopharyngolaryngoscopy and a dual-probe esophageal pH study. LPR was diagnosed by a Koufman RSI of >13 and/or RFS of >7. GERD was diagnosed according to a DeMeester Johnson score of >14.7. Proximal acid reflux was diagnosed if acid exposure time was >0.02% in a proximal pH probe. RESULTS: The study included 30 patients with a voice disorder. The mean age of participants was 38.5 years and 40% of patients were female. Using either of the two criteria, LPR was present in 46.7% of patients, half of whom had GERD. Among the remaining 53.3% patients with a voice disorder and no evidence of LPR, GERD was present in 25%. There was no significant association between the presence of LPR based on RSI (P=1) and GERD or RFS and GERD (P=0.06). Proximal acid reflux was present in only 10% patients with a voice disorder, and there was no significant association of this test with RFS (P=1) or RSI (P=1). CONCLUSIONS: Approximately half of the patients with a voice disorder have LPR, and only a subset of these patients have evidence of GERD. Fiberoptic laryngoscopic findings (RFS) complementing RSI appears to be important in diagnosing possible reflux etiology in voice disorders and can be an indicator for instituting anti-reflux therapy. However, there is no significant association between RSI, RFS, and GERD suggesting that these tests evaluate different features of the disease. Proximal acid reflux is uncommon in patients with voice disorder based on current measurement criteria. Acid exposure time as measured in the proximal probe of a 24-hour dual pH probe may need to be re-evaluated as one of the diagnostic criteria for LPR.
ABSTRACT
The aim of the present study was to identify preoperative clinical predictors for difficult laryngeal exposure (DLE) and to define a simple grading system for laryngeal exposure. This is a prospective descriptive study carried out in a tertiary teaching hospital in South India. Patients above 18 years undergoing microlaryngoscopy had presurgical evaluation of 11 physical parameters. Grading of Modified Cormack-Lehane Score (MCLS) and rigid laryngoscopy were done during procedure. On logistic regression analysis, with a 95 % confidence interval (CI) MCLS was found to be a statistically significant predictor (odds ratio 12). With 90 % CI, neck circumference, atlanto-occipital extension and MCLS were significant (odds ratio of 4, 4, 12 respectively). Neck circumference of more than 34.25 cm and limited atlanto-occipital extension of less than 19.50, predicts difficult laryngeal exposure. A simple grading system for laryngeal exposure during microlaryngoscopy is being proposed. MCLS grade more than 2a done intra operatively correlates well with difficult intubation.
ABSTRACT
Nasolabial cyst, also known as Klestadt's cyst is an uncommon nonodontogenic cyst. Bilateral nasolabial cysts are rarer and less than 10 cases have been reported in the literature. Diagnosis is usually clinical and they present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. A postpartum lady presented with bilateral swelling of the cheeks. Excision was done via a sublabial approach. She is asymptomatic one year after surgery. Nasolabial cysts are developmental but usually noticed after a trauma. There is no data relating the cysts to pregnancy.
