Peritonsillar abscess - Do we need anaerobic cover?

OBJECTIVE: To find out the usability and advantage with regard to the advent of new and more costly antibiotics. In the treatment of Peritonsillar abscess the demonstration of, both aerobic and anaerobic organisms has raised the question of possible need to treat with antibiotics effective against anaerobes. It was in this very context that this study was planned to find out if we still have an economically and easily available antibiotic to treat Peritonsillar abscess. CONCLUSIONS: Injectable penicillin is the drug of choice in PTA as GABHS and staphylococcus aureus coagulase positive are the most common organism associated with this condition. Even where penicillin resistant organism is present, effective management of the abscess is possible if it is drained well and weak hydrogen peroxide gargles are used along with injectable penicillin.

Clinical profile and serum beta-carotene levels in oral submucous fibrosis.

Clinical profile and serum beta-carotene levels in 100 cases of oral submucous fibrosis (OSMF) were studied. Prevalence of OSMF was noted to be 0.93% of new cases attending ENT OPD Age of cases varied from 12 to 78 years (mean 29.09 years) with male-female ratio of 3.3:1 and 80% literacy. Students constituted the single largest group. Burning sensation in oral cavity and inability to open mouth were the chief complaints in 95% cases. In all cases changes in colour of buccal mucosa and palpable fibrous bands in oral cavity were present followed by trismus (99%). About 52% patients were in grade-III OSMF (Journal of Indian Dental Association, 49: 187), oral habits of chewing tobacco, betal nut, etc. were present in 95% patients. Excessive use of chillies was present in 60 and 74% patients were non-vegetarian. Serum beta-carotene levels were below normal in all the three grades of OSMF, lowest being in grade III.

Efficacy of conservative treatment modalities used in epistaxis.

OBJECTIVE: To assess the efficacy of conservative modalities in the management of epistaxis. STUDY DESIGN: Prospective case studies. SETTING: Rural medical college hospital. PATIENTS: Indoor and outdoor patients with epistaxis. LNTERVENTION: Conservative(non surgical) management techniques in epistaxis. RESULTS: Chemical cauterization was successful in 72.07% cases, anterior nasal packing in 84.5% and posterior nasal packing in 95.6% cases. CONCLUSION: Out of 300 cases of epistaxis included in the study (except for one case that required internal maxillary artery ligation). all cases were treated successfully with conservative treatment alongwith treating the underlying pathology causing epistaxis.

Predisposing factors and aetiology of Hoarseness of voice.

A study comprising 110 patients with hoarseness of voice was carried out between Jan 1998 and September 1999 to find out the predisposing factors and aetiology oj the condition Septic foci in nose and throat and vocal abuse were the common predisposing factors observed in 41 8% and 40 9% cases respectively Chronic non specific laryngitis was the commonest aetiology of hoarseness of voice seen in 43 6% of cases.

Clinical profile of hoarseness of voice.

A study comprising of 110 cases of hoarseness was carried out in the department of otolaryngology-HNS, M.G.I.M.S., Sewagram between Jan. 1998 and Sept. 1999. Age of patients ranged between 6 to 71 years. Male to female ratio was 2∶1. Labourers constituted the single largest group of patients (36.36%). Rural to urban ratio was 3∶1. Duration of hoarseness ranged from 1 day to 5 years. Acute laryngitis was the commonest cause of hoarseness.

Pattern of ear, nose, pharynx, larynx and oesophagus(enplo) cancers in a rural based hospital.

A total of 1527 cases of total body cancer (TBC) presented at M G I M S between 1(st) Jan. 1992 to 30(th) April 1999. ENPLO cancers comprised 656 (42.9%)casees. Ca cervix was the commonest cancer amongst TBC comprising 15.3% cases. Ca oral cavity was the commoncest among ENPLO cancers comprising 24.3% cases followed by Ca oesophagus comprising 19.1% Ca oropharynx comprising 16.9%, Ca hypopharynx comprising 13.4%, Ca larynx comprising 11.3% and Ca Nose and PNS comprising 5.7% cases. ENPLI cancers constiuted the major burden of TBC in our hospital.

Peritonsillar abscess-a clinico-bacteriological study.

This study comprised 32 cases of peritonsillar obscess (PTA)constitutint 0.08% of ENT outdoor cases and 0.80% of indoor admission. Age ranged from 14 years to 58 years(mean 34.21 ± 10.25 SD years). Male predominance was seen in the ratio of 1.69:1. A triad of symptoms comprising pain, fever and peritonillar swelling was seen in 29 (90.62%) cases. Ipsilateral jugulodigastric lymphnode enlargement was the commonest sign present in all the cases. Bacterial culture was positive in 25 (78.12%) cases. Most common aerobic organism isolated was Group A beta hemolytic streptococcus (GABHS) seen on 10 (27.77%) cases. Anaerobic culture could be done in 22 cases only. It was positive in 11 (50%) cases. Commonest isolate was Peptostreptococcus seen in 4 (18.18%) cases.

Assessment of oxidative stress and effect of antioxidant supplementation during radiotherapy in carcinoma of upper digestive tract.

Oxidative stress was studied by estimating plasma levels of malondialdehyde (MDA), beta carotene, vitamin E and erythrocytic superoxide dismutase(E-SOD) activity in 50 cases of carcinoma of upper digestive tract which included carcinoma of oral cavity, pharynx and oesophagus. While plasma MDA level was found to be increased (3.5±1.0 nmole/ml), a significant decrease in beta carotene (81.2±14.5mg%), vitamin E (8.5±1.1 mg/L) level and E-SOD activity (657.0±80.6 U/G Hb) were observed in carcinoma of upper digestive tract. Patients were treated with radiotherapy which itself was toxic enough and produced its deleterious effects by generation of reactive oxygen species (ROS). As antioxdiants can detoxify ROS, beneficial effect if any, of antioxidant administration during radiotherapy was studied in two groups of patients, group A (n=5, supplemented with antioxidants) and group B (n=5, without antioxidant supplementation). Plasma MDA level was found to be elevated in both the groups but the increase in group B was significant, compared to pretreatment level. Further, body weight was found to be significantly decreased in group B patients, which was maintained in group A patients. Moreover, group A patients showed significant elevation in beta carotene concentration, thus showing beneficial effect of administration of antioxidants during radiotherapy without disturbing the desirable therapeutic effect of radiotherapy.

Role of ginkgo biloba extract in acquired sensorineural hearing loss.

The present study is on 52 patient of acquired SNHL who were treated with Ginkgo biloba extract (Ginkocer) or conventional treatment (Neurobion, Arlidine & Vit -A) or both. The age range was 11-75 years with male: female - 3.1. Commonest probable etiology was presbyacusis (36.5%) followed by idiopathic (28.8%). Subjective improvement in hearing was comparable in both the ttreatment groups. Objective improvement (> 10 dB ) was seen with Ginkocer therapy only in cases of idiopathic (3). ototoxicity (1) head injury (1). It was maximum in <25 yrs. age and ranged between 11-50 dB. However, statistically it was not significant for age, sex, socioeconomic status, oral habits, Hb level, serum cholesterol and albumin: globulin ratio. Patients showing no effect of drug were almost comparable in both the groups. In conventional group the remaining patients demonstrated drug efficacy of 30% while in the Ginkocer group it was upto 60%. The mean improvement in tinnitus was 52.32% with Ginkocer and 50.09% with conventional treatment. Relative improvement with Ginkocer was found better by 15.56%, 21.94% & 9.09% in presbyacusis, idiopathic: and ototoxicity group as compared to conventional group.

Epistaxis: study of aetiology, site and side of bleeding.

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Bell's Palsy - herpes simplex virus type-1 a possible causative agent.

The role of Herpes Simplex Virus Type 1 (HSV-I) in Bell's Palsy was evaluated according to clinical symptomatology and serologic findings in a series of 41 patients seen over two years period. Four fold rise in antibody titre between the acute and convalescent sera suggesting a primary infection by HSV-1 was seen in 21.9% cases, while arise in titre or a constantly high titre suggesting a reactivation or recurrent infection by HSV-I was obtained in 29.2% cases. In 48.9% cases there was a negative antibody titre. No seasonal clustering was observed. There was no relation between the recovery of facial nerve function with the antibody titre. Key words: Bell's palsy. Herpes simplex virus.

Cysticercosis of submandibular duct.

Cysticercosis is a common platyhelminthes intestinal infection but its presentation in subman-dibular duct is unknown. We report one such case.

Nasal mucous ciliary clearance and olfaction in atrophic rhinitis.

Nasal mucocilliary Clearacne (NMCC) was studied in 75 cases of atrophic rhinitis and results were compared with 35 healthy controls using Anderson's method. Olfaction in atrophic rhinitis decreases but its extent has not been studied earlier. We have tried to quantify olfaction. This was normal in 10.6%, mild hyposmia was seen in 30%, severe in 23.33% and anosmia was present in 36%.

Prochlorperazine versus cinnarizine in cases of vertigo.

Cases of vertigo comprised 1.82% of Ear, Nose & Throat out patient cases. Peripheral lesion as a cause of vertigo was seen in 51.12%. Meniere's disease and Benign Paroxysmal Positional Vertigo (BPPV) were found to be the common causes comprising 21.80% and 15.78% of total cases of vertigo. Central lesion as a cause of vertigo was seen in 48.87% of cases. Vertebre Basilar Insufficiency (VBI) was the commonest cause of central lesion seen in 20.30% of cases. An equal number of cases, selected randomly, underwent treatment with prochlorperazine ± Head Balance exercises and Cinnarizine ± Head Balance exercises. At the end of 5 weeks of treatment there was 100% subjective improvement with prochlorperazine group and 97.14% in the group with cinnarizine. Side effects were noted in 34.00% of cases; of these 23.00% were seen in cinnarizine group and 11.00% in prochlorperazine. Drowsiness was the commonest side effect and was statistically more significant with cinnarzine group. Response to the treatment was significantly more in cases with vertigo of peripheral origin as compared with vertigo of central origin.