Evaluation of the validity of high serum antistreptolysin o titre only, as an indication for tonsillectomy.

Serum Antistreptolysin O (ASO) titre is raised when there is infection of any organ of the body, by Group A beta haemolytic streptococci (GABHS), Group C or Group G streptococci [1]. Increased serum ASO titre should not be the only deciding criterion for tonsillectomy if GABHS is not present in the palatine tonsils. In this study, we evaluate the rationality of performing tonsillectomy in raised serum ASO titre only, in absence of GABHS in palatine tonsil. The study was designed as a prospective cohort study in which the main out come measure is to find out: The main outcome measure is to find out whether only the raised serum ASO titre is to be considered to perform tonsillectomy or not. Fifty consecutive patients (both children and adults) clinically diagnosed to have chronic tonsillitis were included in this prospective cohort study. Throat swab culture, tonsilar core tissue culture and Serum ASO titre tests were performed in all the patients. The results showed that out of the 50 patients 45 had raised ASO titre and 5 patients had normal ASO titre. GABHS was found in 5 cases (10 %) in throat swab culture and 8 cases (16 %) in FNA of tonsil core culture. The sensitivity of throat swab culture as compared to FNA Tonsil core culture was 62.5 % and positive predictive value was 100 %. The sensitivity of ASO titre as compared to core culture was 100 % and positive predictive value was 17.8 %. Specificity was only 12 %. From the results of this study, it is evident that FNA culture of the tonsil core is a valid and a reliable test for the diagnosis of bacterial micro flora in recurrent tonsillitis. One should perform throat swab culture and FNA culture from tonsil core along with ASO titre before doing tonsillectomy in absence of any other indications. Identifying GABHS in the tonsil by FNA test and/or in the throat swab culture along with high serum ASO titre may be one of the ideal indications for tonsillectomy.

Intractable anemia: a case of bleeding nasal cavernous hemangioma.

Cavernous haemangioma of the nose is rare, but when it occurs it usually presents with severe epistaxis. This nasal pathology is mostly seen in adult patient patients. Standard approach to dealing with such haemangiomas is surgical resection. A 30-year-old woman presented to General Physician with history of haemoptysis, haematemesis and weakness. She was admitted for investigation of her severe anaemia. On examination there was no obvious source of bleeding in the mouth or oropharynx, and Upper GI endoscopy did not reveal any pathology. She was referred to us after a trivial episode of epistaxis. Anterior and posterior rhinoscopy did not reveal any abnormality. Her extreme anxiety made indirect laryngoscopy and post-nasal space examination difficult but no obvious abnormality was seen. Diagnostic nasal endoscopy was done, and a small haemangiomatous mass was found in the postero superior part of inferior turbinate. Excision of the mass was done under local anaesthesia and sent for histopathological evaluation. The mass on histopathology came out to be Cavernous haemangioma.

Kawasaki disease: a case report every otolaryngologist should know.

Kawasaki disease is the acute febrile vasculitis of childhood, predominantly affecting medium sized arteries with predilection for coronary arteries. The diagnosis is mainly clinical, though investigations are helpful in early detection of complications. We report a case of Kawasaki disease in a 5 year old child who presented to our hospital with conjunctival congestion, lymphadenopathy and fever. When on treatment with antibiotics did not help resolve symptoms, particularly conjunctival congestion Kawasaki disease was suspected. She was treated with a single dose of intravenous immunoglobulin G, over a period of 12 h. She subsequently developed a systolic murmur with grade I mitral regurgitation not a known complication of Kawasaki disease. She responded to the treatment remarkably and promptly thus evading any fatal complication.

Study on the anatomical variations of the posterosuperior bony overhang of external auditory canal.

To evaluate the extent of posterosuperior bony overhang required to be removed for proper exposure of the incudo-stapedial complex during stapes surgery. Whether an assessment can be made out about the extent of the posterosuperior bony overhang clinically or not. A prospective study. One hundred patients of Stapedial Otosclerosis were included in this study. The direction of the posterosuperior bony canal wall i.e. straight or sloping type was recorded in every patient. All the patients underwent stapedotomy operation under local anaesthesia. The amount of overhang of the posterosuperior bony canal wall required to be removed for adequate exposure of the incudo-stapedial complex during stapes surgery was recorded by using measured right-angled picks of different sizes in mm. The aim of this study is to find out the extent of posterosuperior bony overhang and to know whether the posterosuperior bony overhang is more in straight or sloping bony canal wall. Fifty-seven percent of our patients had a medially sloping posterosuperior bony canal wall and 43% had a straight canal wall, which was noted clinically before surgery. The extent of posterosuperior bony overhang was divided into 4 groups: Gr. A ≤2 mm, Gr. B 2-2.5 mm, Gr. C 2.5-3 mm, Gr. D ≥3 mm. There were 25 patients in Group A, 55 in Group B, 20 in Group C and none in Group D. So majority (i.e. 55%) patients belonged to Group B i.e. 2-2.5 mm. The posterosuperior bony overhang is more in those patients who had straight bony canal than those who had sloping bony canal. This may be clinically assessed and this observation is statistically significant (P < 0.001).

Otitis media with effusion in children and its correlation with foreign body in the external auditory canal.

Otitis Media with Effusion (OME) is difined as the chronic accumulation of mucus within the middle ear and sometimes the mastoid air cell system. Significant hearing loss may go unnoticed and may result in improper development of speech and language. Foreign bodies in the external auditory canal of paediatric patients are commonly encountered in day-to-day practice. The purpose was to see if there is any relation between foreign bodies in ears and otitis media with effusion. A prospective study of consecutive cases was conducted between August 2005 and August 2007 at a teaching hospital. All children presenting with the history of a foreign body in the external auditory canal were included in this study. 50/74 that is 67.8% of the children in the study group had abnormal findings in the tympanogram whereas only 28/74 that is 37.8% children from the control group had abnormal findings in tympanogram. This study indicates that significant eustachian tube dysfunction to frank OME, causes irritation and/or earache in children which may compel them to put things into the ear. So children with an external auditory foreign body must be followed up in an ENT clinic. This may be an early opportunity to diagnose an underlying undetected OME and/or eustachian tube dysfunction in children, preventing the development of any complication from the undetected OME.

Foreign bodies in ENT in a teaching hospital in Eastern India.

OBJECTIVE: To evaluate the nature, common sites, modes of presentation of various foreign bodies (FB) in Ear, Nose and Throat (ENT). MATERIALS AND METHODS: Observational retrospective study carried out at Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan. The study period was between Jan 2006 to Jan 2007. The information obtained from the hospital record books. RESULTS: Four hundred and eighty-two patients presented in the Department of Otorhinolaryngology of Vivekananda Institute of Medical Sciences, in the study period with FB in their ENT. Out of 482 pts, the commonest location of FB was to be in throat with 302 pts (62%) followed by ear with 119 pts (25%) and nose 61 pts (13%). Amongst the FB in throat the commonest was fish bone and the commonest site being tonsils. Artificial denture accounted for a significant number of 13 (4.3%). External auditory canal was the commonest site of FB lodgment in ear found in 118 patients (99.16%). Nasal FB were found in 61 patients; more common in pediatric age group (98.36%). CONCLUSION: From this study we have found that FB lodgement is a very common complaint with which patients come to otolaryngologist. The commonest site of FB lodgement is in the throat. Most of the FB could be removed in emergency room (ER) with or without Local Anesthesia.

Tympanoplasty in children.

Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35-94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.

Acute epiglottitis in adults - a recent review in an Indian hospital.

OBJECTIVES: To examine the mode of presentation, clinical course and treatment of acute epiglottitis in a series of adult patients. METHOD: All adults with acute epiglottitis admitted to teaching hospital over a period of 12 months were included in this retrospective study. The diagnosis of epiglottitis was eatablished by laryngoscopy and soft tissue X-ray neck lateral view. RESULTS: Twelve patients were included. Three patients had concurrent acute tonsillitis. Blood cultures were negative in all the cases. Pathogens were isolated by throat swabs only in three patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of coamoxy-clav and metronidazole was the most common antibiotic regimen used. CONCLUSION: The rising incidence of acute epiglottitis in the adults necessitates the close observance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with more than 50% airway obstruction.

Use of mitomycin C in endo-DCR.

OBJECTIVE: To evaluate the role of topical Mitomycin C in Endoscopic Dacryocystorhinostomy (DCR), for the prevention of stomal stenosis. PATIENTS: Thirty patients undergoing endoscopic DCR for chronic dacryocystitis were studied prospectively. The follow up period was 12 months. TECHNIQUE: PATIENTS were divided into two groups randomly. All of them underwent endoscopic DCR. One group was subjected to topical Mitomycin C application after surgery while the control group was not. MAIN OUTCOME MEASURES: Postoperative relief of epiphora and endoscopic documentation of the patency of the stoma were the main outcome measures. RESULTS: 80% cases of the Mitomycin C group and 86.67% cases of the non Mitomycin C group had long-term successful results. This result is not statistically significant (p> 0.2). CONCLUSION: Intraoperative Mitomycin C application does not alter the long-term results in endoscopic DCR. A properly and adequately performed surgery is more vital for successful result.

3-flap tympanoplasty - A simple and sure success technique.

Objective Three-flap tympanoplasty, a simple method for tympanic membrane repair, is recorded as an alternative method, which probably has advantages over other procedures and its efficacy evaluatedPatients Four hundred and fifty patients with subtotal or large central perforations with either an anterior bony overhang or vers small anterior rim of the perforation who underwent 3-flap tympanoplasty were included in this study Follow up period was 24 months Technique After removing the margin of the tympanic membrane remnant, three flaps (Superior, anterior and posterior) were elevated from the external auditory canal wall The temporalis fascia graft was then placed over the handle of malleus and all the three flaps were repositioned over the graftMain outcome measures The graft take over rate and hearing improvement postoperatively were the main outcome measuresResults Four hundred and twenty-five patients (94 44%) had successful grafts Both subjective and objective hearing improvement with a compliant tympanic membrane was seen in all of these patients postoperatively Mediatisation or lateralisation of the intact tympanic membrane did not occur Twenty-five patients had graft rejection, which was noted about 4 weeks after surgery and was due to infectionsConclusion 3-flap tympanoplasty is a simple technique with a very good success rate It is a useful method for busy practioners and junior otolaryngologists.

Classical Neo-stapedotomy.

Preservation of stapedius muscle and incudo-stapedial joint during stapedotomy for otosclerosis is the motto of the dat. The Study was carried out in 500 patients. In Group A (n = 140), the stapedius muscle and incudostapedial joint were preserved. In Group B (n = 360), the stapedius muscle was cut. One month after surgery in Group A patients, the Stapedius-Reflex (SR) was evoked in 75% and three months later in 90%. The mean Loudness Discomfort Level (LDL) after one month of surgery in Group A was 95dB while three months after it was increased to 110dB. Speech discrimination score (SDS) in Group A with 80 dB suprathreshold is 93% and in Group B it is only 72%. This study established the fact that the preservation of stapedial muscle and incudo stapedial join is beneficial and essential, whenever possible, in the surgery for otosclerosis.