CT and MR imaging of the inner ear and brain in children with congenital sensorineural hearing loss.

Imaging plays an important role in the evaluation of congenital sensorineural hearing loss. In children who are candidates for cochlear implantation surgery, it provides vital preoperative information about the inner ear, the vestibulocochlear nerve, and the brain. High-resolution computed tomography (CT) and magnetic resonance (MR) imaging provide excellent delineation of the intricate anatomy of the inner ear: CT depicts the minute details of osseous structures, and MR imaging allows visualization of the fluid-filled spaces and the vestibulocochlear nerve. Together, these complementary modalities can aid decision making about the best management strategy by facilitating the identification and characterization of inner ear malformations and any associated neurologic abnormalities. It is important that the radiologist be familiar with the key imaging features when interpreting CT and MR images obtained in this patient group. A broad spectrum of inner ear malformations have been described and linked to developmental insults at different stages of embryogenesis, and various systems have been proposed for classifying them. In this article, these malformations are described by using classification systems used by otolaryngologists for ease of interpretation. The relevant normal anatomy and development of the inner ear are briefly surveyed, standard imaging protocols for studying the inner ear are reviewed, and the imaging appearances of frequently observed inner ear malformations are described and illustrated. The impact of the identification of these malformations and commonly associated brain abnormalities on clinical management and prognosis also is discussed.

Kawasaki disease (syndrome)-our experience-.

Kawasaki disease also known as mucocutaneous lymph node syndrome is a generalised vasculitis of unknown etiology. Presenting a review of the literature and using our cases for illustration we discuss some of the pertinent features in the evaluation and management of patients with this condition. 2 cases of Kawasaki disease have been evaluated and treated in the department of ENT and Paediatrics who responded satisfactorily to treatment with I.V.Immunoglobulin and Aspirin. The case reports have been presented in view of the rarity of reporting of similar cases in India and the need for early diagnosis and prompt treatment to prevent coronary artery aneurysm and other serious complications.

Kikuchi - Fujimoto disease.

Kikuchi - fujimoto disease also known as histiocytic necrotizing lymphadenitis is an idiopathic benign self limiting condition with a favourable outcome, usually affecting young women. The following cases have burn reported for clinical interest and for the rarity of the reports about this condition in ENT literature. In our series, we had 2 female patients aged 18 years and 25 years respectively and a male patient aged 45 years, presenting with fever, bilateral tender multiple cervical adenopathy including posterior triangle nodes not responding to routine antibiotics and anti-inflammatory drug treatment. ENT findings were within normal limits. Routine clinical investigations were within normal limits except for the raised ESR. Biopsy from one of the enlarged glands revealed necrotizing lymphadenitis. All the patients subsequently showed significant improvement locally in the neck and systemically without any further active treatment.

Classification of nasal septal deviations-Relation to sinonasal pathology.

The relationship between sinonasal disease and septal deriations is well known, albeit vaguely. There was no serious attempt to classify deviations except calling them mild deviations, gross deviations, spur; high deviations, etc. The airflow changes in these deviations, which lead to mucosal changes predisposing to polyps or infection have not been documented clearly. In this study we made a classification of septal deformities by modifying the classification described by Mladina in 1987. This classification has been applied to 100 consecutive cases who have been advised nasal surgery and 100 normal individuals who did not have any nasal symptoms. All patients had CT scan of PNS and their CT findings were studied in relation to the type of deviation. This paper presents an analysis of the incidence of various types of deviations in patients and controls and the relationship of different deformities to the sinus pathology.

Surgical management of some unusual Parapharyngeal space Tumors.

We present out experience with the surgical management of 8 cases parapharyngeal tumors which were successfully operated using various approaches. Most tumors were quite large and presented special surgical challenges to safegaurd important structures and ensure complete tumors excision. Included in the series are 3 rare tumors, a myoepethilioma of the deep lobe of parotid, a Glomus intravagale tumor and a case of extra osseous Ewing's sarcoma. Depending on tumors location and extent, the transcervical, transparotid and midline mandibulotomy approaches were used and the techniques are described. All patients are currently doing well without any evidence of disease.

Invasive Sino Nasal Aspergillosis diagnostic criteria.

This study highlights the high incidence of fungal granulomas in our patients and to streess the need to differentiate the invasive Sinonasal aspergillosis from the non invasive ones because, the management og invasive Aspergillosis includes the administration of the potentially toxic drug, Amphotericin. The various diagnostic criteria used by us to identify the cases for systemic anti fungal treatment in addition to through local debridement are discussed.

Management of tongue base obstruction in obstructive sleep apnoea syndrome.

Studies have shown that the obstruction in OSA is more often than not multicentric. Tongue base obstruction is relatively more difficult to diagnose accurately and treat effectively. In this presentation, an effort is made to suggest two methods of management of this problem. One deals with the surgical management and the second, an alternative non-surgical method.

Glomus intravagale tumour-a case report.

Paragangliomas are uncommon tumours arising from chemoreceptor organs. Those arising in relation to the vagus nerve are referred to as Glomus intravagale or vagal body tumours. They are rare tumours accounting for only 3% of Head & Neck paragangliomas. A case of Glomus intravagale tumour is presented both in view of its rarity and to stress its differentiation from a carotid body tumour which in this case was possible only at the time of surgery.