Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial.

OBJECTIVE: To assess the effect of tranexamic acid in head and neck surgical procedures. METHODS: A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients' group allocation (case or control). RESULTS: Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant. CONCLUSION: Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.

Isolated tubercular hypoglossal nerve paralysis.

Hypoglossal nerve palsy is not an uncommon neurological finding but primary nasopharyngeal tuberculosis (TB) presenting as hypoglossal nerve palsy is very rare. A 31-year-old woman presented with headache and progressive tongue deviation towards the right side. Diagnostic nasal endoscopy revealed soft tissue mass lesion on the posterior wall of nasopharynx while MRI revealed isointense tumour in nasopharynx with normal hypoglossal nerve and brain. Histopathological examination found TB. We discuss the clinical challenges and possible pathogenesis of this rare clinical entity.

Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision.

OBJECTIVE: To assess cardiac functions in adenotonsillar or tonsillar hypertrophy. METHODS: A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy. RESULTS: There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement. CONCLUSION: Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.

Killian's polyp mimicking malignant tumor.

Killian polyp is predominantly found in children and any sinonasal tumor in elderly presenting with epistaxis and pain usually indicates malignant growth until proved otherwise. We present an unusual case of Killian polyp in an elderly patient that behaved as a malignant tumor. This case report reminded us that paranasal sinuses are still dark hollow mysterious cavities, and we should take utmost clinical acumen in managing such cases.

Schizophillum commune causing sinusitis with nasal polyposis in the sub-Himalayan region: first case report and review.

Schizophillum commune is an environmental fungus rarely causing human infections of diverse nature. Sinusitis occurs in immunocompromised persons and seldom in healthy subjects. Though easily isolated, the lack of awareness of its virulence is a bottleneck in the diagnosis of this infection. We report the first case of S. commune sinusitis with nasal polyps in an immunocompetent male from the sub-Himalayan region. The computerized tomography scan findings established the clinical diagnosis, and causative agent was confirmed as S. commune. A white, woolly mold with septate, hyaline hyphae and characteristic spicules but unclamped connections suggested a monokaryotic isolate. Patient was treated successfully with fiberoptic endoscopic sinus surgery, and no antifungal therapy was instituted. There was no recurrence at review after 1 year.

Unusual delayed presentation of head trauma complicating outcome of facial nerve decompression surgery.

Late presentation of head trauma is rare. A young boy presented with a traumatic facial paralysis after head trauma. A CT scan of the head showed temporal bone fracture without intracranial insult. Facial nerve decompression was performed and paralysis started improving. However, he presented with vertigo and sensorineural hearing loss after 2 months. Clinical examination also showed cerebellar sign. We suspected iatrogenic injury to the cochlea; however, brain MRI showed haemorrhage in the area of anterior inferior cerebellar artery. The patient was managed conservatively and the vertigo improved. This case stresses on unusual late presentation of head trauma and cerebellar artery injury that complicated the outcome of facial nerve paralysis.

Coexistence of bilateral first and second branchial arch anomalies.

Branchial arch anomalies are one of the most common congenital anomalies that are usually unilateral and bilateral presentation is rare. The simultaneous presence of bilateral second branchial arch anomalies along with bilateral first arch anomalies is extremely rare, with only three such cases reported in the literature. We present two non-syndromic cases of coexisting bilateral first and second arch anomalies. Developmental anomalies of the branchial apparatus account for 17% of all paediatric cervical masses and are the most common type of congenital cervical mass. They usually present in the paediatric age group. About 96-97% of these anomalies are unilateral. Bilateral presentation is seen in 2-3% having a strong familial association. Congenital syndromes also have been associated with first and second branchial arch anomalies. Thorough clinical examination and investigations should be done to rule out these syndromes.

Tonsillitis with acute myeloid leukemia: a case series for caution.

Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.

Fibrolipoma of the eustachian ostium.

Nasopharyngeal fibrolipoma is extremely rare, with only four case reports in the literature. However, lipoma of the eustachian tube is the rarest with a single case report in the literature. A 50-year-old woman presented with obstruction of both nostrils for the past 1 year. CT scan showed a mass in the postnasal space extending from the right side of the nasopharynx to the oropharynx. The nasal endoscopy found a polypoidal mass arising from the posterior-inferior margin of the right eustachian tube ostium and extending to the oropharynx. Histopathological examination of the excised polyp found features suggestive of fibrolipoma. Fibrolipoma is characterised by prominent bundles of mature collagenous or myxocollagenous stroma intermixed with mature adipocytes. CT is useful in the diagnosis of lipoma but MRI is preferable. This is the second case of eustachian tube fibrolipoma to be reported in the literature that emphasises the role of nasal endoscopy and rarity of this tumour.

Otoacoustic Emissions in Otitis Media with Effusion: Do They Carry any Clinical Significance?

Otoacoustic emissions have been advocated in the management of otitis media with effusion. However, otoacoustic emissions cannot differentiate different types of hearing loss. This study was conducted to find factor that can differentiate otitis media with effusion from other common causes of hearing loss in children. Children were enrolled in the study and divided in four groups consisting of 25 ears each after pure tone and impedance audiometry: (1) Otitis media with effusion group, (2) Normal ear group, (3) Sensory-neural hearing loss group, (4) Chronic suppurative otitis media group. Otoacoustic emissions were recorded and results were analyzed statistically. The normal hearing group had significant difference from other groups but total band reproducibility of transient evoked otoacoustic emissions did not show any statistical difference in the cases groups. In distortion product otoacoustic emissions, group 1 showed significant difference from group 3 and group 1 had significant difference from all other groups at 4 kHz. The study did not find any factor that differentiates otitis media with effusion from other diseases. Although, distortion product otoacoustic emissions can indicate otitis media with effusion but impedance audiometry should be the main tool in the management of otitis media with effusion.

Auditory brainstem evoked responses in hyperlipidaemia: effect of various lipid fractions on auditory function.

OBJECTIVE: To evaluate the effect of different lipid fractions on auditory brainstem evoked responses in hyperlipidaemia. METHOD: We conducted a single institution (medical college), prospective, cross-sectional study of 25 hyperlipidaemic patients and 25 normolipidaemic controls, all with a normal hearing threshold on pure tone audiometry. Brainstem evoked response audiometry results were recorded in both groups. The hyperlipidaemic group were further divided into two subgroups, based on the serum value of each lipid fraction: those with less than and those with greater than the mean serum value. These two subgroups were further compared with the control group. RESULTS: The hyperlipidaemic and normolipidaemic groups had statistically significant differences for all audiometry waves apart from the wave I and the III-V interpeak latencies. The subgroups had a statistically significant difference in brainstem evoked responses. We found a statistically significant association between low-density lipoproteins and many waveforms in the hyperlipidaemic group. CONCLUSION: We found that low-density lipoproteins were significantly associated with many waveforms in hyperlipidaemic patients. Thus, low-density lipoproteins may be important in auditory dysfunction.

Evoked response audiometry in scrub typhus: prospective, randomised, case-control study.

OBJECTIVE: To investigate the hypothesis of cochlear and retrocochlear damage in scrub typhus, using evoked response audiometry. STUDY DESIGN: Prospective, randomised, case-control study. METHODS: The study included 25 patients with scrub typhus and 25 controls with other febrile illnesses not known to cause hearing loss. Controls were age- and sex-matched. All subjects underwent pure tone audiometry and evoked response audiometry before commencing treatment. RESULTS: Six patients presented with hearing loss, although a total of 23 patients had evidence of symmetrical high frequency loss on pure tone audiometry. Evoked response audiometry found significant prolongation of absolute latencies of wave I, III, V, and wave I-III interpeak latency. Two cases with normal hearing had increased interpeak latencies. These findings constitute level 3b evidence. CONCLUSION: Findings were suggestive of retrocochlear pathology in two cases with normal hearing. In other patients, high frequency hearing loss may have led to altered evoked response results. Although scrub typhus appears to cause middle ear cochlear and retrocochlear damage, the presence of such damage could not be fully confirmed by evoked response audiometry.

Cisplatin-based chemotherapy: Add high-frequency audiometry in the regimen.

BACKGROUND: Cisplatin-induced ototoxicity shows high interindividual variability and is often accompanied by transient or permanent tinnitus. It is not possible to identify the susceptible individuals before commencement of the treatment. We conducted a prospective, randomized and observational study in a tertiary care centre and evaluated the effects of different doses of cisplatin on hearing. MATERIALS AND METHODS: Fifty-seven patients scheduled for cisplatin-based chemotherapy were included in the study. All patients were divided into three groups depending on the dose of cisplatin infused in 3 weeks. RESULTS: The subjective hearing loss was found in seven patients, while six patients had tinnitus during the chemotherapy. The hearing loss was sensorineural, dose dependent, symmetrical, bilateral and irreversible. Higher frequencies were first to be affected in cisplatin chemotherapy. CONCLUSION: As use of high-frequency audiometry is still limited in research work only, we need a strict protocol of adding high-frequency audiometry in the cisplatin-based chemotherapy regimen.

Cervical neuroblastoma.

Cervical neuroblastoma is relatively uncommon. It present, most often as a firm mass in the lateral neck. Primary neuroblastomas of the neck usually arise in the cervical sympathetic ganglia. They are the sixth most common head and neck extracranial neoplasms. Neuroblastoma is the most common malignancy in children under 1 year of age. No known cause of Neuroblastoma has been reported.

Clinicopathological and radiological evaluation of cervical lymph node metastasis in head and neck malignancies.

The cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each).

Alternating extra medullary plasmacytoma of maxilla.

Plasmatytomas of maxilla are rare lesions. Alternating plasmacytoma of maxilla is still rare. A case of maxillary extra medullary plasmacytoma is reported in a patient, who presented with same lesion in the opposite maxillary sinus within one year of initial presentation. On review of available literature we could not find bilateral medullary plasmacytoma involving both maxilla one after another.

An autogenous foreign body in tracheobronchial tree.

Foreign body in the trachea is not uncommon but foreign body of autogeneous origin is rare with stray dog bite.

Melkersson-rosenthal syndrome.

Melkersson - Rosenthal syndrome was described by Melkersson and Rosenthal separately in the year 1928 and 1931 respectively. It is supposed to be a rare syndrome of bilateral alternating recurrent facial paralysis alongwith fissured tongue and oedema of the lips, face and eyelids. A case of Melkersson - Rosenthal syndrome is reported with all the classic findings which is a rarity. In this case there was alternating facial paralysis to begin with followed by bilateral paralysis third time, along with oedema of lips and face, fissured tongue, and dialation of sig-moid colon with absence of haustrations.

Bilateral intra parotid tubercular lymphadenitis.

Tubercular parotitis is an extremely rare clinical condition which is difficult to diagnose. The rarity of this condition can be seen from the evidence of only a few reported cases in the litera-ture. Tubercular infection is quiet common in this part of the world, but Tubercular Parotitis is still a rarity. A case of Bilateral tubercular parotitis diagnosed by FNAC, showing tubercular involvement of the intra parotid lymph node is presented due to its rarity.