Thyroglossal Duct Remnants: A Comparison in the Presentation and Management Between Children and Adults.

Seventy one patients (43 children and 28 adults) of thyroglossal duct remnants (TGDRs) presented at a tertiary care institute from January 2001 to September 2017 were retrospectively analysed. The mean age of presentation was 7.15 years in children and 26.85 years in adults. The male to female ratio was 1.9:1 among children and 1.8:1 among adults. The most common presentation in children was a thyroglossal fistula (53.48%) whereas it was a painless cystic neck swelling (89.29%) in adults. All the children underwent a Sistrunk's operation whereas 78.57% of the adult patients underwent simple excision of cyst/fistula using the modified incision (Yadav's incision). Recurrence developed in one child and one adult patient who underwent Sistrunk's operation and none in the modified incision, these cases were treated with a second stage procedure. In conclusion, compared with adults, more children presented with a discharging thyroglossal fistula. The thyroglossal duct remnants can be managed successfully by simple excision in adults.

Aural Polyp is not Always Due to Chronic Otitis Media (COM): Preoperative Computed Tomographic Scan is Good Pointer for Sinister Lesions.

Twenty five patients of aural polyp who underwent canal wall down mastoidectomy were analysed retrospectively. Histopathological examination revealed cholesteatoma in 22 (88%) patients. However, histopathological diagnosis in 3 of these patients was unusual and rare benign tumors of the middle ear cleft-meningioma, neurilemmoma and capillary hemangioma. Review of the preoperative High Resolution Computed Tomography (HRCT) temporal bone revealed an unusual picture in all of the three cases. Features noted were: widening of the jugular foramen (meningioma), destruction of the anterior wall of mesotympanum (neurilemmoma), enhancing soft tissue density lesion (capillary hemangioma). Further, there was only partial loss of pneumatisation of the mastoid air cells in all of the 3 cases. It was observed that though HRCT temporal bone is a commonly advised investigation in patients of chronic otitis media (COM) with aural polyp, meticulous interpretation may reveal unusual features pointing towards sinister diagnosis. Conclusion: Aural polyp with preservation of pneumatisation of mastoid air cells points towards diagnosis other than COM.

Treatment of Tympanic Membrane Retraction Pockets by Excision and Cartilage Tympanoplasty: A Prospective Study.

To assess the role of cartilage tympanoplasty in management of retraction pockets of the pars flaccida. This was a prospective study at a tertiary care centre. Twenty patients having grade III or grade IV retraction pockets were included in the study. Retraction pockets were treated by excision and cartilage tympanoplasty. Findings noted on follow-up were recorded and analysed. Graft was taken up in 18 (90%) cases with residual perforation in 2 (10%) cases. Recurrence of retraction pockets was observed in 6 (30%) cases. Hearing was improved up to 15 dB in 16 (80%) cases. It is concluded that grade III and IV retraction pockets can be well managed by excision and cartilage tympanoplasty.

Second Branchial Anomalies: A Study of 94 Cases.

Ninety-four patients with second branchial anomalies were retrospectively analysed at a tertiary care centre from January 2006 to September 2016 to determine the demographical data and management. Branchial sinus and fistula presented earlier as compared to branchial cyst. The mean age at presentation in case of branchial sinuses, fistulae and cysts was 5.07, 5.79 and 7.31 years respectively. There was preponderance in males as compared to females, more so in bilateral cases. Male to female sex ratio was 2.91:1. The branchial fistulae were the most common type of lesions, followed by the branchial sinuses. The branchial anomalies were more on the right side (65.96%) probably due to right handedness of the population. Only eight patients (8.51%) had bilateral anomalies. Four patients had familial association, it was seen in bilateral cases and they presented earlier than unilateral cases. Early and complete surgical excision is the treatment of choice. Preoperative sinogram/fistulogram and intraoperative methylene blue dye injection is not mandatory for excision of a branchial sinus/fistula. Post-operative wound infection was the most common complication (4.25%).