Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective.

Objective: The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Study design: Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. Results: The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. Conclusion: A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.

Esthesioneuroblastoma as a collision tumor.

Esthesioneuroblastoma is an uncommon malignant neoplasm of nose and paranasal sinuses. Esthesioneuroblaslvma presenting as a collision tumour is very rare. The case of such a rare presentation is being reported here in a patient with previous history of squamous cell carcinoma uvula, post irridiatted; who now developed a bleeding nasal mass which proved to be a collision timour c ontaining both squamous cell carcinoma and Esthesioneuroblastoma on biopsy.

Penetrating oesophageal foreign body.

The behaviour of impacted foreign bodies in the Oesophagus is very often unpredictable. Though penetration with subsequent migration into the thyroid gland is an extremely rare event, with only occasional reports in medical literature, this possibility should always be borne in mind because of the likelihood of serious complications like aorto-oesophageal fistula, subctavian-oesophageal fistula and retropharyngeal abscess. The usual presenting features are persistent pain and foreign body sensation with no evidence of the foreign body on converntional oesophagoscopic examination.

Pneumothorax following tracheostomy and its management.

Although pneumothorax is a known complication of tracheostomy, bilateral pneumothorax is comparatively rare. The case of suuh a complication is being reported here in a patient with a glottic carinoma who underwent emergency trackeostamy and developed hilaterluttrl pneuimothoriax and its subsuente. management is discussed.