Pediatric epistaxis: epidemiology, management & impact on quality of life.

OBJECTIVE: Epistaxis in the pediatric population is a common problem for both primary care physicians (PCPs) and otolaryngologists. Although a frequent reason for referral to ENT clinics, data is lacking regarding causes, effects on quality of life and common treatment modalities. METHODS: Prospective, clinical and questionnaire based study, with ethical approval. We identified 50 cases of pediatric epistaxis (<16 years old) over a 6-month period. A thorough clinical history was taken, first aid measures and management outcome was recorded. The impact of recurring epistaxis on parental quality of life was assessed using the Parental Stress Index Short Form (PSISF). RESULTS: Thirty-three males and 17 females (2:1) were included. Mean age at presentation was 8.8 years. Initial management was inadequate, with only 30% of carers applying appropriate first aid measures. Quality of life was significantly affected in 10% of cases with primary parental concerns being fear of excessive blood loss and the stress of soiled bedclothes and night wear. Children were most affected by the negative impact on sporting activity. Otolaryngology consultation found the common causes to be iatrogenic trauma and rhinitis affecting "Littles" area. Of which 78% required silver nitrate cautery, and 22% just required reassurance and advice CONCLUSIONS: Recurrent minor nosebleeds in children can be troublesome and alarming for parents and children. We found the PSISF an easy and reliable method of assessing patient and parental stress in dealing with this problem. Raising awareness of simple management strategies among parents and PCPs could significantly reduce associated quality of life issues. Mucosal hydration, cautery and first aid advice are the fundamentals of management.

Rhinosporidiosis in Delhi, north India: case series from a non-endemic area and mini-review.

We report three cases of rhinosporidiosis from migrant population of Delhi. Three male patients had sino-nasopharyngeal, nasopharyngeal and nasal rhinosporidiosis, respectively. One patient gave a history of bathing in stagnant water. The diagnosis was made by clinical presentation and microscopic observation of characteristic sporangia of Rhinosporidium seebri in mycological and histopathological investigations. All the patients were successfully treated with complete surgical excision of lesions and cauterization of base. There were no recurrences.

Lipoid proteinosis (Urbach-Wiethe disease): a case report from India.

Lipoid proteinosis (Urbach-Wiethe disease) is a rare autosomal-recessive anomaly that primarily affects the skin and the mucosa of the upper aerodigestive tract in children. It is caused by hyaline deposits in tissues. Hoarseness secondary to laryngeal involvement is frequently the first presenting feature. It is important to consider this disease in the differential diagnosis of hoarseness because it might lead to life-threatening airway compromise. We report a case of lipoid proteinosis in a 12-year-old girl who presented with hoarseness and skin lesions.

Two cases of neurilemmoma of the tongue.

Neurilemmomas of the tongue are uncommon. When they do occur; treatment is simple. However; diagnosis is invariably delayed because of the vagueness of symptoms. We encountered 2 cases of this unusual tumor within weeks of each other In 1 of these cases, the definitive diagnosis was delayed because of the atypical clinical picture-that is, an abscess in the tongue that had caused respiratory distress. We describe our management of these 2 cases, and we discuss what has been published in the literature regarding the presentation, diagnosis, histopathology, treatment, and prognosis for patients with glossal neurilemmoma.

Resistance to erythromycin and rising penicillin MIC in Streptococcus pyogenes in India.

There has been worldwide resurgence in the incidence of Streptococcus pyogenes infection and its sequelae. S. pyogenes remains uniformly susceptible to penicillin, and it is speculated that its minimum inhibitory concentration (MIC) has not changed during the past 70 years. The purpose of the present study was to determine the occurrence and pattern of resistance to penicillin and erythromycin amongst clinical isolates of S. pyogenes. A total of 34 clinical strains of S. pyogenes were identified by standard procedures. Antimicrobial susceptibility was analyzed by the Kirby-Bauer method of disk diffusion, and the E-test method was used to determine the MIC to penicillin and erythromycin. All the strains were sensitive to penicillin, clindamycin and vancomycin on disk diffusion. Ten (29.4%) strains were resistant to erythromycin. The pattern of macrolide resistance observed was M type. By the E-test method, 7 (20.6%) strains were penicillin nonsusceptible and 6 (17.6%) were erythromycin resistant. We concluded that surveillance of its susceptibility pattern is crucial to monitoring the development of antibiotic resistance in S. pyogenes.

A case of skull base mucormycosis with osteomyelitis secondary to temporal bone squamous cell carcinoma.

We describe an unusual case in which a 35-year-old man presented with skull base mucormycosis with osteomyelitis secondary to squamous cell carcinoma of the temporal bone. We also review the literature on the clinical characteristics, diagnosis, and treatment of mucormycosis.

Functional voice disorders and their occurrence in 100 patients of hoarseness as seen on fibreoptic laryngoscopy.

During a six month period, one hundred patients presenting with the primary complaint of hoarseness, in the out- patients department of otolaryngology at Safdarjung Hospital New Delhi were taken up fot the study Fach patient after being subjected to a detailed history- taking and examination, including a Fibreoptic Laryngoscopy was then put into one of ten categories on the basis of the ultimate diagnosis Functional voice disorders, forming the largest category with 51%, included lesions such as vocal nodules and polyps, which are secondary to vocal abuse A detailed study of the various types of functional voice disorders along with factors such as male female ratio and associated contributory factors was done the efficacy of the Fibreoptic laryngoscope as a diagnostic tool was also assessed.

An unusual case of primary nasal tuberculosis with epistaxis and epilepsy.

Primary nasal tuberculosis is rare. We report a case that was all the more extraordinary because of the age and sex of the patient (an 11-year-old boy), the unusual associated symptoms (epistaxis and grand and seizures), and the presence of intracranial extension. Clinical and radiologic findings on our initial evaluation suggested that the patient had a large sinonasal malignancy. The patient manifested no evidence of pulmonary tuberculosis. The diagnosis of primary nasal tuberculosis was established only after we obtained the results of histopathology of the excised mass and a subsequent tuberculin skin test; the diagnosis was confirmed by the patient's rapid response to antituberculosis drug therapy. We also review the relevant literature on this rare condition.