A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region.

Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.

Lidocine Infiltration Test: An Useful Test in the Prediction of Results of Styloidectomy for Eagle's Syndrome.

Eagle's syndrome is caused by elongated styloid process. Its accepted treatment is styloidectomy. However more than one-fourths of patients undergoing styloidectomy do not experience relief. To find the utility of the lidocaine infiltration test to predict the results of styloidectomy in patients clinically diagnosed as having stylalgia. Twenty-six patients undergoing styloidectomy for Eagle's syndrome were included in the study. They were divided into two groups depending on their response to lidocaine infiltration in the tonsillar fossa. Patients were followed up till 3 months after styloidectomy and their pre operative visual analogue scale for pain was compared with the post operative VAS score. Majority of the patients were females and in the fifth decade of life. There were 18 patients in group I and eight patients in Group II. The groups were similar in terms of age and sex distribution and pre operative VAS score for pain. There was good corelation between post infiltration and post operative VAS scores. The test had 94.44 % sensitivity and 87.5 % specificity. The age and sex distribution and the failure rates in the present study were similar to that reported in other studies. There are many other reasons besides elongation which can cause the typical pain of stylalgia and some of them are not amenable to styloidectomy. The lidocaine infiltration test is an useful test to predict the results of styloidectomy for Eagle's syndrome.

A study of flexible fiberoptic bronchoscopy aided tracheal intubation for patients undergoing elective surgery under general anesthesia.

A difficult airway complicates up to one tenths of cases of elective general anesthesia. Such situations can be anticipated and tackled by fiberoptic flexible bronchoscopy (FFB) assisted tracheal intubation. To study the indications and outcomes of FFB assisted tracheal intubation in patients with anticipated difficult airway, who are undergoing surgery under general anesthesia. Cases who were intubated using FFB assistance were included in the study. Detailed examination was done pre operatively to be able to predict the difficult airway. Intubation was done with the help of a FFB after induction of general anesthesia. There were total 52 cases. Majority were male and in the fourth decade of life. Oral submucous fibrosis was the commonest indication for the procedure. There were two cases of failure, but no significant mortality or morbidity. A difficult airway can be encountered across specialties. It can be anticipated by simple or multi factorial methods. Awake FFB aided intubation is the gold standard in cases of anticipated difficult airway. Failure rates of 4-66 % have been reported. In the present study the failure rate was less than 4 % with no morbidity or mortality. FFB assisted intubation is safe and effective in paediatric patients too. FFB assisted intubation done in an organised and skilled manner is a very important skill to have to tackle cases of difficult intubation. Hence it should be included in training programmes of anesthesia.

A comparative study of two different uncinectomy techniques: swing-door and classical.

INTRODUCTION: The aim of this study was to determine which technique of uncinectomy, classical or swing door technique. MATERIALS AND METHODS: Four hundred eighty Cases of sinusitis were selected and operated for Functional Endoscopic Sinus Surgery (FESS). Out of these, in 240 uncinectomies classical uncinectomy was done whereas in another 240 uncinectomies swing door technique was used. Initially patients were medically managed treated according to their symptoms and prior management. Patients who had received previous adequate medical management were evaluated with CT scan of the sinuses. If disease still persists than they were operated for FESS. RESULTS: The authors' experience indicates that Functional endoscopic sinus surgery can be performed under local or general anesthesia, as permitted or tolerated. In this review classical technique was used in 240 uncinectomies. Out of this, ethmoidal complex injury was noted in 4 cases, missed maxillary ostium syndrome (incomplete removal) was reported in 12 patients and orbital fat exposure was encountered in 5 patients. As compared to 240 uncinectomies done with swing door technique, incomplete removal was evident in 2 cases and lacrimal duct injury was reported in 3 cases. 'Evidence that underscores how this 'swing door technique' successfully combines 'the conservation goals of the anterior-to-posterior approach and anatomic virtues of the posterior-to-anterior approach to ethmoidectomy of the total 480 uncinectomies operated. Out of which 240 uncinectomies have been performed using the 'swing-door' technique. The 240 uncinectomies performed using classical technique were used as controls. The incidence of orbital penetration, incomplete removal, ethmoidal complex injury and ostium non-identification was significantly less with the new technique. Three lacrimal injuries occurred with the 'swing-door' technique compared to no injuries with classical technique. CONCLUSION: The authors recommend swing door technique as it is easy to learn, allows complete removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus without injuring the ethmoidal complex.

Castleman's Disease, a Case report.

INTRODUCTION: Castleman's disease is a rare lymphoproliferative disorder which may be confused with other causes of lymphadenopathy. CASE REPORT: Here we report a case of unicentric Castleman's disease presenting with cervical lymphadenopathy. The patient was treated with complete surgical excision of lesion and was disease free at the time of reporting this article. This case has been reported for its rarity. CONCLUSION: Though castleman's disease is a relatively rare entity it should be strongly considered in the differential diagnosis of cervical lymphadenopathy.

Anterior jugular phlebectasia.

Phlebectasia is abnormally dilated vinous channels a rare differential diagnosis for an apparent neck swelling A 5 year old male child with neck swelling apparent only on crying and speaking presented to us It was a soft cystic swelling The diagnosis was confirmed by sonography and angiography Surgical excision was carried out without any complication.