Laryngotracheal stenosis: clinical profile, surgical management and outcome.

Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis. Materials and Methods It is a study of 60 cases with chronic LTS. It includes retrospective study of 30 cases treated from 2004 and prospective study of 30 cases from Jan 2007 to Dec 2009. A total of 60 cases with LTS were enrolled in the study. Patients were assessed clinically by eliciting detailed history and analyzing previous records. After assessment of extent of stenosis, they were subjected to surgical interventions (endoscopic/open approach). Outcome after surgical interventions was assessed. Results 60 patients were included in the study, in the age group of 2.5-50 years. There were 46 (77%) male patients and 14 (23%) female patients. Intrinsic trauma, secondary to prolonged intubation was the most common cause of LTS, seen in 23 (38%) cases followed by post traumatic stenosis (strangulation-18 (30%), blunt injury-15 (25%), penetrating neck injury-4 (7%)). Stenosis was divided into 6 types based on subsite involvement. Of which, cervical trachea was the commonest site of involvement (25/60 cases). Majority of cases had fixed vocal cords at presentation (55%), more commonly due to post traumatic injury. 60 cases had undergone a total of 110 surgical procedures (endoscopic-56,open approach-54). In the end, overall decannulation rate is 93.3%. In site wise tracheal stenosis, isolated subglottis, combined glottis and subglottic stenosis had decannulation rate of 100% each and with mobile vocal cords, the success rate is 96%. Conclusions Post traumatic stenosis with fixed vocal cords is more common in our practice. Categorizing stenosis into various subtypes helps in treatment planning and predicts surgical outcome. Tracheal or subglottic stenosis with mobile vocal cords has better success rate.

Osteoma of the paranasal sinuses.

Osteamas of the paranasal sinuses are rare, They often appear as a coincidental finding on X-ray in patients having radiographs for same other reasons. Tomographic evaluation is the mainstay surgical access and its subsequent follow up. We report a series of 20 cases of osteamas of the paranasal sinuses who underwent surgery for their symptoms. Wide exposure at surgery is necessary for complete or near complete removal. Tumour close to the dura, optic-nerve and internal carotid artery may be left Close and long period offollow-up is essential, especially when the tumour is partially left behind. In our experience, the rate of growth of tumour is very slow and a wait and watch policy can he adopted for very small tumours and those that are incompletely resected.

Tuberculosis of the maxillary sinus manifesting as a facial abscess.

Tuberculosis of the maxillary sinus is rare. Likewise, an acute onset that necessitates incision and drainage is also very uncommon. We report the case of a 15-year-old girl who came to us with an abscess on the left side of her face. She was found to have tuberculosis of the left maxillary antrum.

Vertigo syndromes and mechanisms in migraine.

This paper attempts to define and categorize the vertigo associated with migraine. A retrospective chart review of 344 cases of vertigo identified 19 cases with headaches characteristic of migraine as per strictly defined criteria (International Headache Society, 1988). Four distinct types of vertiginous syndromes were noted. The commonest syndrome (Group I) manifested transient episodes of imbalance with additional momentary subjective rotary vertigo worsened by movement. The attacks lasted a few hours and evaluation in the inter-episode interval demonstrated no vestibular deficit. Group II manifested transient objective rotatory vertigo of from 10 minutes to a few hours but no demonstrable permanent vestibular deficit. Group III displayed symptoms and signs characteristic of benign paroxysmal positional vertigo (BPPV) and Group IV manifested a permanent unilateral labyrinthine weakness. Causation of vertigo by migraine was implied in 10 of 19 cases where the headache and vertigo occurred simultaneously and in two other cases where the vertigo improved with anti-migraine prophylactic treatment. Four distinct and characteristic vertigo syndromes have been noted with migraine. Their spectrum ranges from a transient reversible dysfunction to a more permanent destruction, and includes involvement of both the peripheral and the central vestibular systems.

Computers in Otorhinolaryngology : New horizons.

There has been an explosion in the computers and information technology in the past couple of years. Otorhinolaryngology has also seen a number of new applications of computers. This article aims to familiarize the reader with different uses of computers as applied to the field of Otorhinolaryngology. It deals with the role in medical literature search, patient and doctor education, medical record Keeping, telemedicine, internet and E-mail. creating virtual environments and its role in FESS, skull base tumors and plastic surgery.

Entomophthoromycosis of the nose and paranasal sinus.

A case of entomophthoromycosis of the nose and paranasal sinus is presented. To our knowledge, this is the youngest patient reported with this infection. Though the clinical picture mimicked a malignancy, histopathology clinched the diagnosis of entomophthoromycosis. The lesions resolved completely with oral potassium iodide.

Congenital supraglottic cyst: a rare cause of stridor.

Congenital laryngeal cysts are very rare and if mismanaged, lead to a high incidence of morbidity and mortality. The case may present as severe stridor and emergent management can obviate a tracheostomy, achieving cure in the process. We report here a case of supraglottic cyst, which was completely occluding the airway and was managed in the emergency setting.

The particle repositioning maneouvre for benign paroxysmal positioning vertigo.

Thirteen consecutive cases wherein Benign Paroxysmal Positional Vertigo was diagnosed are retrospectively reviewed. The Dix-Hallpike positioning test was classically positive with a typical torsional, down beating, transient nystagmus in four of these thirteen cases. The diagnosis in the other nine was based on a suggestive history with or without subjective vertigo on the positioning test. Ten cases improved with labyrinthine suppressants and habituation exercises alone. This included all the patients wherein the Dix-Hallpike maneouvre did not elicit any nystagmus. However, in the group wherein the Dix-Hallpike maneouvre resulted in nystagmus, only one of the four improved and the particle repositioning maneouvre (PRM) was employed in the three cases with persistent symptoms. Two had immediate relief of symptoms. The particle repositioning maneouvre was repeated after three days in the one other patient and proved successful on this second occasion. Surgical treatment was not necessitated in any case, It is proposed that the particle repositioning maneouvre should be the preferred first-line treatment for any patient who on Dix-Hallpike testing demonstrates nystagmus typical of BPPV.

Molecular graphics and structural fitting of aromatics in large-pore zeolites.

We describe the usefulness of molecular graphics and structural fitting techniques as powerful and reliable tools for quick screening of zeolite catalysts for shape selectivity. The syntheses of 4,4'-diisopropylbiphenyl and p-isobutylethylbenzene are considered as case studies. Molecular graphics analysis of the isomers of diisopropylbiphenyl and isobutylethylbenzene in various zeolites indicates that large-pore zeolites are needed for the synthesis of these alkylaromatics. The importance of size and shape of the channels of large-pore zeolites is clearly brought out by the structural fitting technique. From the analysis of the results of molecular graphics studies and the structural fitting studies, it is inferred that ZSM-12 and mordenite are suitable zeolites for shape-selective production of diisopropylbiphenyl, and that offretite and mordenite are suitable zeolites for shape-selective production of p-isobutylethylbenzene.

Rhinosporidiosis: a study that resolves etiologic controversies.

We have been able to isolate the cyanobacterium Microcystis aeruginosa from water samples of ponds and river where patients of rhinosporidiosis were bathing. It is likely that this cyanobacterium is the causative agents of this disease. The bluish-green cells of M. aeruginosa also have a colorless small cell stage called nanocyte which has been detected in clear waters of all the pond and river samples studied. Both large cells and nanocytes of M. aeruginosa could be recognized inside the round bodies of rhinosporidiosis by light and electron microscopy. Further work on culturing this organism from excised samples and evaluation for drug therapy are in progress. It is hoped that, if therapy becomes available, no surgery would be required for this disease. It is suggested that the waters from ponds and lakes, as well as municipal and recreational waters, be checked for the nanocyte stage of M. aeruginosa. Etiological controversies of rhinosporidiosis have been reasonably solved. The new findings justify a change in the name "rhinosporidiosis" that had been associated with the fungus Rhinosporidium Seeberi.

Parapharyngeal neurofibromas.

This paper is a retrospective study of 15 patients with parapharyngeal neurofibromas operated over a six year period. No patient presented with a neurological deficit. CT scans revealed a well encapsulated moderately enhancing mass in ten cases. The tumour was removed by a transcervical approach in ten cases while in five a cervical-transpharyngeal route with mandibulotomy was used; in three of the latter group the tumour was retropharyngeal. In two cases a recurrence was successfully excised. It was realized that a mandibulotomy was required when the internal carotid was displaced medially, or if the tumour extended to the base of skull or when its vertical diameter exceeded 8 cm.

Hearing loss after head injury.

Sixty head injury patients were evaluated for hearing loss; ten underwent ABER testing. Forty percent of the cases had hearing loss of different degrees. The audiometric pattern was variable in the different types of injuries, although the incidence of conductive deafness was quite low (5%). In most of the cases of sensorineural hearing loss, the end organ was implicated. Recruitment was demonstrated in the ABERs, as well as in the retrocochlear lesions, by studying the IPLs present.

Vestibular functions in conservatively treated chronic renal failure.

Chronic renal failure can produce malfunction of multiple organs, including auditory and vestibular apparatus. Twelve patients of chronic renal failure of varying etiologies treated conservatively were subjected to vestibular function tests. Only 33% of the patients had normal ENG data. Fifty-eight per cent of the patients had canal paresis and 8% showed hyperactive response. Ototoxic drugs like furosemide may be most important factor in aetiology of vestibular dysfunction in chronic renal failure.