Current bacteriological profile of tonsillar surface versus core tissue in patients undergoing tonsillectomy.

PURPOSE: The current study explored the bacteriological profile in the tonsillar core in patients undergoing tonsillectomy and compared it with tonsillar surface organisms. The antibiotic sensitivity and resistance patterns were also studied. MATERIALS AND METHODS: This prospective and observational study was conducted in the Department of Otorhinolaryngology, Head and Neck surgery in a tertiary care institute, on a total of sixty-one patients clinically diagnosed as chronic tonsillitis and undergoing tonsillectomy. Tonsillar surface culture swabs and core tissue specimen were sent in separate vials. The culture isolates and their antibiotic sensitivity were analysed and compared. RESULTS: Bacterial growth was detected in 61% of the cases, in cultures from the surface or the core tissue or both. 50.8% specimens of core tissue versus 31.1% of tonsillar surface samples revealed bacterial growth. Of the 13 cases in which surface and core both had bacterial culture growth, the same pathogens were identified in 8 cases. Pseudomonas aeruginosa was the most commonly reported organism in both tonsillar core as well as surface swab cultures. CONCLUSION: Our study shows that surface swab culture is not always a reliable indicator of organisms present in core of tonsils in cases of chronic infection. The surface swabs did not always match the pathogens in the core. The higher prevalence and the variability of pathogenic organisms in the core tissue as compared to the surface suggests that a targeted antibiotic treatment based on surface culture swabs is unlikely to eradicate them.

Awake videolaryngoscopic orotracheal intubation in patients with laryngeal tumour using the C-MAC D-Blade.

Background and Aims: This study assessed the applicability of C-MAC videolaryngoscope (VL) D-blade for awake intubation in patients with laryngeal tumour. The primary study objective was to determine the rate of successful intubation in the first attempt. The other parameters recorded were number of attempts required for intubation, duration of different stages of intubation, haemodynamics, ease of intubation and patient comfort on visual analogue scale (VAS) postoperatively. Methods: Thirty patients were studied. Patients were sedated with dexmedetomidine and fentanyl as a slow bolus (over 20 min) and Ramsay sedation score was assessed. Topicalisation of the oropharynx, tonsillar pillars and base of the tongue was done with lignocaine 10% spray. Four ml of 4% lignocaine using MADgic atomiser was used for anaesthetising the glottis and the tracheal lumen. Results: Successful intubation was achieved in 86.6% patients in first attempt and 13.3% in two attempts. Total time for all intubations was less than 30 seconds. Fremantle score was F-1-C-MAC D-blade (easy intubation with full view) in 60% patients, while 23.3% had F-2-C-MAC D-blade (full view and either required more than one attempt or a modified technique), 13.3% had P-1-C-MAC D-blade (partial view with easy intubation) and 3.3% had P-2-C-MAC D-blade (partial view and required more than one attempt or a modified technique). The VAS score for anaesthesiologist's ease and for patient's experience was 85.83 ± 7.20 and 86.66 ± 14.46, respectively. Conclusion: C-MAC VL D-blade-assisted awake intubation is an effective and safe method to manage the airway of patients with laryngeal tumour once adequate topicalisation is ensured before the procedure.

Correlation of fine needle aspiration cytology with histopathology in patients undergoing thyroid surgery.

<b>Introduction:</b> Thyroid swellings are one of the most common swellings in the neck. They pose a major problem in developing countries like India, considering the high endemicity for iodine deficiency disorders. Thyroid gland is affected in many conditions. Out of these, majority are benign while less than 5% are malignant. Multiple noninvasive and invasive diagnostic tests are available for the diagnosis of thyroid swelling. However, at present, FNAC is considered the gold standard investigation. Despite the high sensitivity and specificity, FNAC has its limitations. Histopathological examination of surgically excised thyroid swelling is the confirmatory gold standard to determine the pathology of the thyroid gland. <br><b>Material and method:</b> This prospective and observational study was conducted in the Department of Otorhinolaryngology (ENT) in collaboration with the Department of Pathology in a tertiary care hospital and medical school. A total of seventy patients were included. <br><b>Results:</b> The diagnosis on FNAC was correlated with histopathology. Statistical analysis showed FNAC had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 96.7%. However, the overall accuracy in this study was determined to be 95.71%. Results were found to be statistically significant (P < 0.05). <br><b>Conclusions:</b> The diagnostic role of FNAC in thyroid lesions is of utmost importance in making preoperative diagnosis. FNAC was found to be highly sensitive and specific for diagnosing thyroid lesions but the final HPE is considered as a gold standard.

Bacteriological Profile in Attico-antral type of Chronic Suppurative Otitis Media.

Chronic suppurative otitis media is defined as a chronic inflammation of the middle ear cleft, which presents with recurrent ear discharge through a tympanic membrane perforation. The purpose of this study was to find pattern of bacteriology in patients of atticoantral type of chronic suppurative otitis media as it will help the clinician to decide the effective antibiotics to be prescribed. This prospective and observational study was conducted in the Department of ENT in collaboration with Department of Microbiology, Government Medical College and Hospital, Chandigarh. The ear discharge specimen of all patients meeting the inclusion criteria were collected and sent for microbial examination. Culture positive samples were subjected to antibiotic sensitivity. A total of one hundred ears (mean age 27.33 years) clinically diagnosed with chronic suppurative otitis media, atticoantral type were included in this study based on the preset inclusion and exclusion. The male: female ratio in our patients was 0.94:1. Ninety-seven (96.9%) patients had unilateral disease, while 3 (3.1%) patients had bilateral disease. Twenty-eight percent of the total samples were sterile. The most common bacteria isolated were Pseudomonas aeruginosa (27.1%), Methicillin sensitive Staphylococcus aureus (23.3%) and Proteur mirabilis (6.5%). was sensitive to polymyxin B (100%) followed by ciprofloxacin (46.4%), neomycin (42.9%) and gentamicin (42.9%). Polymyxin B is the most effective antibiotic against the cultured bacteria followed by gentamicin, ciprofloxacin and neomycin.

Tumor Budding and Worse Pattern of Invasion Can Predict Nodal Metastasis in Oral Cancers and Associated With Poor Survival in Early-Stage Tumors.

The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lymph node (LN) metastasis status. Early-stage (T1/T2 N0M0) OSCC comprises a heterogeneous group. We evaluated the role of histological parameters including worst pattern of invasion (WPOI) and tumor budding to determine the risk of LN metastasis in cases of OSCC and to determine the risk of recurrence and death in early-stage OSCC in north Indian patients. All cases of buccal mucosa and tongue SCC which underwent excision over 4 and half years were reviewed for histological parameters including histologic grade, WPOI, tumor budding, lymphovascular emboli (LVE), perineural invasion (PNI), depth of invasion (DOI), host lymphocyte response, and stromal response and compared to LN metastasis. Clinical follow-up of early-stage tumor was obtained and compared. A total of 126 cases of OSCC were included, of which 48 showed LN metastasis. Histological grade, WPOI, tumor budding (≥3/×40 field), LVE, and PNI were significantly associated with risk of LN metastasis. On multivariate analysis, WPOI and tumor budding were 2 most significant factors. Among the early-stage tumors with available follow up (n = 48), DOI, WPOI, tumor budding, and LVE were associated with a shorter overall survival, although it was not statistically significant. To conclude, WPOI and tumor budding are important risk factors for predicting LN metastasis in all stages of OSCC and associated with a poorer outcome in early-stage tumors. These are easy and reliable prognostic factors and should be included in the histopathological reporting guidelines.

Extraosseous Ewing's Sarcoma of the Parapharyngeal Space - A Rare Entity - with Review of Literature.

INTRODUCTION: Extraosseous Ewing's sarcoma (EES) of the head and neck region is a rare occurrence, and Ewing's sarcoma of the parapharyngeal space is even rarer. To the best of our knowledge, only three cases of EES of the parapharyngeal space have been reported in the literature. CASE REPORT: We report a rare case of EES of the parapharyngeal space in an 8-year-old girl. She presented with complaints of earache, difficulty in breathing and swallowing and bleeding from the mouth. Investigations revealed a large parapharyngeal mass causing narrowing of the nasopharyngeal and oropharyngeal airway with skeletal and lung metastasis. Biopsy from the parapharyngeal mass was suggestive of malignant small round cell tumor. The patient was treated with chemotherapy and radiotherapy, but developed brain metastasis and succumbed to disease approximately 1 year after diagnosis. Herein, we describe the characteristic clinicopathological features and treatment with a comprehensive review of the literature. CONCLUSION: EES in this unusual location behaves aggressively, with a high rate of recurrence and distant metastasis. Aggressive multimodal treatment comprising of multi-agent chemotherapy, surgical resection if feasible, and radiotherapy should be considered.

Adenoid cystic carcinoma: A study of 19 cases of salivary and extra-salivary tumours diagnosed by fine needle aspiration cytology.

BACKGROUND: Adenoid cystic carcinoma (ACC) arises at sites where seromucinous or sweat gland epithelium is present and commonly affects the salivary glands. Rarely it can occur at extra-salivary locations. METHODS: A retrospective analysis of 19 cases of ACC diagnosed on fine needle aspiration cytology (FNAC) over a period of 15 y (2002-2016) was made. RESULTS: Of 19 total cases, there were 10 salivary and 9 extra-salivary ACCs. Extra-salivary tumours were seen in 2 cases each in trachea, tongue and in one case each in bronchus, lung, subcutaneous tissue, maxillary antrum, and external auditory canal. The age ranged from 14-80 y (mean: 49.5 y), 10 patients were male and 9 were female. The smears were highly cellular in 11 cases, moderately cellular in 5 cases while 3 cases were paucicellular. Multilayered dense clusters, tissue fragments, dispersed cells and cup-shaped fragments were seen. Relatively uniform cells with high nuclear: cytoplasmic ratio, hyperchromatic nuclei, irregular margins, and nuclear moulding were observed. Variable sized hyaline globules, finger-like hyaline material, hyaline cylinders, and hyaline cords were noted. The cytologic diagnosis of ACC was rendered in 13 cases while in 6 cases it was one of the differential diagnosis including monomorphic adenoma, membranous variant of basal cell adenoma, adnexal tumour, polymorphous adenocarcinoma, and pleomorphic adenoma (PA). CONCLUSIONS: Cytologists must be aware of varied locations where ACC can occur. A diagnosis of ACC must not rely exclusively on the occurrence of hyaline globules but necessitates a close scrutiny of cellular and nuclear features to avoid diagnostic pitfalls.

Role of Neck Dissection in Clinical T3N0M0 Lesion of Oral Cavity: Changing Trend.

INTRODUCTION: Neck dissection is an important part in the management of head and neck malignancies especially in terms of control of nodal metastasis. The study is focused on evaluating the profile of lymph nodes in T3N0M0 lesion of different subsides of oral cavity. AIM: To evaluate the utility of neck dissection in T3N0M0 stage of carcinomas of the different region of oral cavity. MATERIALS AND METHODS: Ninety patients aged 20 to 70 years underwent treatment for carcinoma of the oral cavity at our center between 2005 and 2013. Of these, 39 patients were stage T3N0M0 and underwent excision of the primary lesion with neck dissection. The data were collected retrospectively from hospital record library. These patients were evaluated clinically, radiologically and compared with intra operative finding. Addition of radiotherapy was decided on final histopathology. RESULTS: Out of 39 patients, the site of primary tumour in 21 patients was tongue, in 13 patients was Buccal Mucosa (BM), in 2 patients was lip and in 3 patients was Floor of Mouth (FOM) with tongue. In patients with clinically negative neck nodes, ultrasonography and intra-operative examination revealed the presence of suspicious nodes in 35.9% and 30.7% cases respectively. Occult metastasis in the nodes was identified on histopathological examination in 15 patients (38.5%). A total of 14 patients of carcinoma of tongue and one patient of BM showed positive nodes on histopathology. These patients with positive neck nodes on histopathology, were sent for postoperative radiotherapy. At follow up examination, four patients showed local and distal recurrence and they were managed accordingly. Out of 39 patients, 11 patients of BM, 2 patients of lip, 1 patient of FOM and 6 patients of tongue were disease free in last follow up. CONCLUSION: Selective neck dissection is an effective therapeutic intervention in patients without clinically involved neck nodes. It can upstage the tumour and additional treatment may be advised. In patients with carcinoma of buccal mucosa and lip, the patients can be kept under regular follow up when biopsy report showed excision with adequate margin and no nodal metastasis.

Evaluation of brush cytology and DNA image cytometry for the detection of cancer of the oral cavity.

BACKGROUND: Cancer of the oral cavity is the sixth most common malignancy reported worldwide. This study was undertaken to evaluate the efficacy of brush cytology and the adjunctive role of DNA image cytometry (ICM) in the diagnosis of oral cancer. METHOD: Oral brush smears and biopsy were obtained from 100 consecutive patients presenting with suspicious oral lesions. DNA-ICM was performed on 96 cytology smears which had adequate cellularity. RESULTS: On cytology, 54 cases were benign, 36 were malignant, 6 were suspicious for malignancy, and 4 were inadequate due to scanty cellularity. On histopathologic examination, 49 cases were diagnosed as squamous cell carcinoma and 51 cases as benign. The sensitivity of brush cytology for the detection of cancer was 83.3% and the specificity was 95.8%. The positive and negative predictive values were 95.2% and 85.2%, respectively, with a diagnostic accuracy of 86%. Out of 96 cases analyzed by image analysis to assess DNA ploidy, 33 cases were aneuploid and 63 were diploid. The sensitivity, specificity, positive predictive value, and negative predictive value of DNA-ICM were 68.7%, 100%, 100%, and 76.1%, respectively, giving a diagnostic accuracy of 81%. The combination of cytology and DNA cytometry increased the sensitivity to 92% and specificity to 100%. CONCLUSION: The study demonstrates the usefulness of DNA-ICM as an adjunct to brush cytology to diagnose oral cancer. It reduces the false negative cases on cytology and also adds to objectivity in cytologically doubtful cases.

Intraoral and Oropharyngeal Lesions: Role of Fine Needle Aspiration Cytology in the Diagnosis.

The oral cavity is affected by a wide range of pathologic lesions, for which a morphologic diagnosis is required for proper management. Fine needle aspiration (FNA) is being increasingly used for preliminary diagnoses of such lesions. This is retrospective analysis of intraoral and oropharyngeal lesions diagnosed with FNAC over a period of 7 years. Out of total 55 cases, a definite diagnosis could be made on cytology in 50 cases (90.9 %). These 50 cases were further included in the study. Thirty cases were reported as non-neoplastic and 20 as neoplastic (11 benign and nine malignant). The diagnoses were made taking into account the background material (blood, mucin) and the predominant cells present (neutrophils, lymphoid cells, macrophages, hemosiderin laden macrophages, squamous cells, basaloid cells, spindle cells, giant cells). Histopathological diagnosis was available in 17 cases and corresponded with FNA diagnosis in 16 cases (94.12 %). No significant complications were seen in patients undergoing these FNAs. It can be concluded that FNA is a simple and rapid diagnostic test that can be useful for preliminary assessment of oral and oropharyngeal lesions.

Tuberculous Otitis Media Leading to Sequentialib Bilateral Facial Nerve Paralysis.

INTRODUCTION: Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. CASE REPORT: The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. CONCLUSION: Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications.

Tumours of Deep Lobe of Parotid Gland: Our Experience.

Parotidectomy surgeries are being routinely performed by ENT surgeons nowadays. Parotid tumours can present with a variety of manifestations ranging from a barely noticeable mass to a large tumour with facial paralysis. Most benign parotid tumours are located in the superficial lobe though rarely deep lobe may also be involved, while malignant tumours are generally seen to involve both the lobes of the gland. We present clinico-radiological-pathological profile of 25 patients who underwent parotid surgeries for tumours involving deep lobe alone or the whole gland, and were operated at our institute during the period from January 2011 to December 2012. This study was a retroprospective observational analysis with the aim of analyzing the epidemiology, radiological, surgical and histopathological profile of these patients. Among 25 patients who underwent parotid surgeries, 17 patients underwent total conservative parotidectomy, while 5 patients underwent radical parotidectomy. In 3 patients, extended radical parotidectomy was performed. We also report the complications and follow-up of these patients. We concluded that fine needle aspiration cytology (FNAC) findings and final histopathological report may not always correlate.

Tracheal T-tube stent for laryngotracheal stenosis: ten year experience.

INTRODUCTION: The purpose of this retrospective study was to evaluate the outcome following stenting over a period of 10 years in patients with chronic laryngotracheal stenosis. MATERIALS AND METHODS: Between 2000-2010, out of 111 patients with laryngotracheal trauma, 71 underwent tracheal T-stenting for laryngotracheal stenosis in the Department of Otorhinolaryngology at the Government Medical College and Hospital, Chandigarh, India. All 71 patients underwent stenting by tracheal T-stent through an external approach. The follow-up period ranged from 3-10 years (mean, 3.2 years). The tracheal T-stent was removed after a minimum period of 6-12 months. RESULTS: The majority of patients in this study were aged less than 10 years or between the ages of 20-30 years. A pre-operative tracheostomy (emergency or elective) was performed in all patients. of 71 patients, decannulation was not possible in six (8%). CONCLUSION: Management of laryngotracheal stenosis is a challenging problem that demands a multidisciplinary approach from surgical teams well trained in this field. The ideal treatment option should be individualized according to patient characteristics. The use of silastic stents has both advantages and disadvantages.

Non-neoplastic salivary gland lesions: a 15-year study.

The spectrum of salivary gland lesions is wide and the relative incidence of neoplastic versus non-neoplastic lesions is variable in different studies. A series of non-neoplastic salivary gland lesions is reviewed to analyze their spectrum and their relative frequency. This is a retrospective study of salivary gland excisions and biopsies received in our department from January 1994 to December 2008. Routine hematoxylin and eosin-stained sections of all the salivary gland excisions and biopsies received were analyzed. Of the 393 salivary gland excisions and biopsies received, 216 cases were reported as non-neoplastic (55%) and formed our study group; 177 (45%) were neoplastic. Non-neoplastic lesions were more frequent in major salivary glands (65.7%) and submandibular gland was the most commonly involved (66.2%). Lip was the most frequent site (81.7%) for minor salivary gland lesions. Inflammation was the predominant pathological finding (49.5%), of which non-specific chronic sialadenitis constituted the majority (86.9%). Sialolithiasis was present in 22 cases (20.6%); all of these cases were of non-specific chronic sialadenitis. Cysts were second in frequency (36.6%), of which mucocele was the most common (54.5%). There were 5.6% cases of benign lympho-epithelial lesions, while normal salivary gland tissue was seen in 6.5% cases. Non-neoplastic salivary gland diseases are more common than neoplastic diseases and have a wide disease spectrum.

Invasive rhino-orbital aspergillosis.

Invasive aspergillosis usually affects immune-compromised patients and is common in diabetics. Proptosis, visual loss and ophthalmoplegia due to intra-orbital extension are common presentations. Three out of five patients in our series were immune-compromised. All the patients had visual loss and three patients presented with unilateral blindness. Three patients were treated by surgical debridement followed by Amphotericin B therapy. Two patients who had intra-cranial extension of the disease died during the treatment. Only one patient had improvement in vision following the treatment. High index of suspicion in immune-compromised patients, early diagnosis and prompt aggressive treatment is required to achieve clinical cure.

Malignant melanoma of the mucous membranes of the head and neck: three case reports.

Primary malignant melanoma of the oronasal region is rare. When it does occur, it is difficult to manage, and the prognosis is not good. Early diagnosis and radical surgical management appear to offer the best hope of curing the disease. We report 3 new cases of malignant melanoma of the mucous membranes of the head and neck. Despite the generally poor outlook, 2 of these patients underwent excision of the tumor and remained disease-free 2 years later; the other patient refused surgery and was lost to follow-up.

Tracheoesophageal fistula: New option in management.

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.

Myxolipoma of the epiglottis in an adult: a case report.

Lipomas of the larynx are rare. When they do occur, they are important because some require that the surgeon perform a tracheotomy to prevent a fatal airway obstruction. We report a case of myxolipoma-that is, a lipoma with foci of myxomatous degeneration-of the epiglottis in a 56-year-old woman. We successfully treated the tumor with intubation and surgery; tracheotomy was not necessary. To the best of our knowledge, myxolipoma of the epiglottis in an adult has not been previously reported in the English-language literature.

Parapharyngeal paraganglioma: diagnosis on fine-needle aspiration.

Carotid body tumors constitute the third commonest group of parapharyngeal tumors. Newer diagnostic modalities such as computed tomography scan, magnetic resonance imaging, and Doppler ultrasound are commonly used for diagnosing lesions at this site. However, simple technique of fine-needle aspiration (FNA) cytology is rarely performed in apprehension of complication of hemorrhage. Present case report is of carotid body paraganglioma diagnosed on FNA without any complications and thus providing definite preoperative diagnosis to the surgeon.