Otogenic brain abscess: management by otologist.

INTRODUCTION: Fifty per cent of brain abscesses in adults and 25 per cent of those in children are otogenic in origin. The current neurosurgical options are to drain the abscess repeatedly through burr holes or to excise it completely with the capsule. We successfully managed 10 cases of brain abscess by draining through the transmastoid route. The technique and its advantages are discussed. MATERIAL AND METHODS: The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route. RESULTS: In eight cases, ear disease and brain abscess were treated in a single-stage procedure. In the remaining two cases, residual brain abscess was excised subsequently by our neurosurgical colleagues. CONCLUSIONS: Transmastoid drainage of pus can successfully treat mastoid disease and brain abscess in a single surgical intervention. Residual abscess can be subsequently excised, with relatively reduced morbidity. Repeated needling is also avoided with this approach. Diffusion-weighted imaging and proton magnetic resonance spectroscopy are helpful.

Direct laryngoscopic observations in progressive hoarseness of voice.

Hoarseness is a common disorder of voice which indicates abnormality at the level of glottis. We present our study of forty cases of progressive hoarseness of voice who underwent direct laryngoscopy during a period of January 2003 to January 2004 in our hospital. The observations were recorded und the data was evaluated.

Unilateral choanal atresia: Presentation in adults.

Unilateral choanal atresia usually presents later in life than the bilateral one and may present in adults. We discuss three cases of unilateral choanal atresia, which have presented in adult age group and with complaints not clearly pointing to the diagnosis. The role of CT scan in diagnosis and nasal endoscope in the treatment has been discussed.

S M R of inferior turbinate in chronic hypertrophic rhinitis.

A study was undertaken to evaluate the role of unilatcral/bilateral submucous resection of the inferior turbinates in fifty cases of chronic hypertrophic rhinitis. Patients associated with deflected nasal septum or sinus infectious were excluded from the study. Decongesiton of turbinates was done to exclude the cases with predominantly mucosal hypertrophy. Gertner (1984) plate method was used to asses the nasal patency preoperatively and then post-operatively at 1, 3 and 6 months follow up. The analysis of observations made revealed SMR of inferior turbinate to be a very effective modality tor relieving nasal obstruction due to bony turbinal hypertrophy. The procedure has least interference with nasal mucosal integrity and functions and complications associated with the procedure have been found to be minimal. Histopathological examination of mucosa and of ostenid tissue revealed infiltration by chronic inflammatory cells suggesting chronic nonspecific inflammation either due to non-specific infections and / or allergy).

An unusual impacted foreign body oesophagus in an infant.

Although foreign bodies in aerodigestive tract are quite common in children, but presence of an impacted, sharp foreign body which needed removal by trans-cervical oesophagotomy is quite rare and is thus being reported.

Sino-nasal carcinoma with multiple cutaneous secondaries.

An unusual case of an Anaplastic carcinoma of sino-nasal tract (maxillo-ethunoid angle) with multiple secondary deposits in the skin without lymph nodes and other known distant metastatic sites involvement is being reported.