Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy.

PURPOSE: The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy. DESIGN: This is a prospective, randomized, controlled, single-blind study. SETTINGS: Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population. PATIENTS: Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered. METHODS: A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result. RESULTS: The success rate was 82.3% when MMC was used and 85.7% among the controls (P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group. CONCLUSION: Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.

Foreign bodies in the aerodigestive tract--a clinical study of cases in the coastal belt of South India.

PURPOSE: To investigate the cases of foreign body in the aerodigestive tract and to elucidate the characteristic problems in India. DESIGN AND SETTING: Three hundred patients presenting with a history of either aspirating or swallowing a foreign body were analyzed in a tertiary care center. Data were collected by retrospective chart review and statistically analyzed. RESULTS: Of the 300 patients studied, 90% (270 cases) did have a retained foreign body, with 233 (86.2%) cases found in the pharyngoesophagus and 37 (13.7%) cases in the tracheobronchial tree. With foreign bodies in the tracheobronchial passages, the most common sign and symptom were rhonchi (50%) and dyspnea (67%), respectively; in pharyngoesophagus, the most common symptom and sign were dysphagia (64%) and odynophagia (45%), respectively. The most common foreign body found was fish bone in 39% (106 cases) and the most common site of lodgment was the cervical esophagus 50.5% (136 cases). Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality. Thirty-three (12.2%) cases had complications secondary to retained foreign body. CONCLUSION: Foreign bodies in the aerodigestive tract continue to be a common problem affecting adults and children alike. Rigid endoscopies with forceps removal under general anesthesia are the preferred management modality. From their experience, the authors recommend that no foreign body in the upper aerodigestive tract should be left alone with the hope that it will come out spontaneously. Delay in diagnosis and management can lead to life-threatening complications.

Aural polyps: safe or unsafe disease?

PURPOSE: To determine whether a case of inflammatory aural polyp constitutes a safe or unsafe disease and to arrive at the most suitable treatment option. DESIGN: Prospective study. Follow-up period of 6 months. SETTING: Hospitalized treatment in a tertiary medical college hospital that provides care for a predominantly rural population. PATIENTS: All patients treated for aural polyp, having a postoperative histopathological diagnosis of inflammatory aural polyp. Most patients (72%) belonged to the lower middle class. RESULTS: Forty-two patients treated during a 4-year-period were analyzed. Eleven cases were treated by simple aural polypectomy, of which 78% had either recurrence or persistent disease. Out of 31 patients who underwent mastoid exploration, 52% had extensive disease of the mastoid air-cell system and 35% had an underlying cholesteatoma. Six percent had persistent discharge. The disease was often associated with complications (19%). CONCLUSIONS: The presence of an aural polyp signifies well-established disease of the middle ear cleft with a greater potential for complications and often obscures an underlying cholesteatoma. We propose that all cases of aural polyps should be considered as unsafe disease and subjected to a formal mastoid exploration.