Prevalence of fungal infection in nasal polyposis - A cross-sectional study, conducted at a tertiary care hospital in Karachi.

OBJECTIVE: To determine the prevalence of fungal infections causing nasal polyposis (AFRS-Allergic fungal rhino sinusitis) in the local population. METHODS: It is a cross sectional study, carried out from October 2010 to January 2015 on 221 patients in the ENT Department of Abbasi Shaheed Hospital and Karachi Medical & Dental College in collaboration with the microbiology department. This study included patients who had a clinical diagnosis of nasal polyposis with or without fungal infection on the basis of nasoendoscopic examinations. All patients underwent Functional Endoscopic Sinus Surgery (FESS) and the diagnosis of (AFRS-Allergic fungal rhino sinusitis) was considered after histopathological confirmation of eosinophilic mucous containing hyphae. Numerator included the total number of patients who presented to the ENT out-patient clinic of Abbasi Shaheed Hospital suffering from nasal polyposis secondary to fungal infection during the follow-up period of the study. On the other hand, denominator included all the patients who attended the ENT out-patient clinics during the same follow-up period. This determined the period prevalence of fungal infections in nasal polyposis at a tertiary care centre in Karachi. RESULTS: Data was collected, a descriptive analysis was performed and a Computed Tomography (CT) grading was done. On the basis of histopathology, 90 (40.7%) patients were found to have fungal infection. CONCLUSIONS: The prevalence of fungal infections was 40.7% (90 patients) in nasal polyposis.

Schwannoma of Nasal Inferior Turbinate in Young Male: A Rare Occurrence.

A12-year old boy presented to the ENT Department of Abbasi Shaheed Hospital, Karachi, with a one year history of progressively increasing unilateral right sided nasal obstruction. He denied any other symptoms like that of rhinorrhea, epistaxis, facial pain, headache and any history of nasal trauma. After routine clinical examination, CT scan nose/PNS with contrast was advised and subsequently biopsy was done that revealed the mass to be as schwannoma. This was then removed via a lateral rhinotomy approach and the postoperative specimen again revealed the same. The boy was followed for 1-year and no recurrence is seen. He is still in the follow-up phase.

Facial nerve morbidity following surgery for benign parotid tumours.

OBJECTIVE: To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. METHODOLOGY: Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. RESULTS were described as frequency percentages. RESULTS: Out of 235 patients, 159 (67.65%) were female and 76 (32.35%) were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour (n=194, 82.6%), followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 (72%) patients and nerve dysfunction was observed in 66 (28%) patients. Complete paresis involving all the branches of facial nerve was seen in 25 (10.6%) patients and 41 (17.4%) patients were having incomplete dysfunction. Of these, 62 (26.3%) recovered and 04 (1.7%) had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 (86.3%) cases. CONCLUSION: The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours.

Frequency of tracheobronchial foreign bodies and their management in urban population of Sindh.

OBJECTIVE: To assess the common foreign bodies in urban areas of Sindh, and the presentation, problems and complications during their removal through rigid bronchoscopy. METHODS: The descriptive study was conducted at the Ear, Nose and Throat Department and the Department of Head and Neck Surgery of Liaquat University Hospital, Hyderabad, and Abbasi Shaheed Hospital, Karachi, from April 2009 to October 2010. Fifty patients with strong suspicion of foreign body inhalation in whom rigid bronchoscopy was done were included in the study. A definitive diagnostic protocol was applied and rigid bronchoscopy was done to search and remove the foreign bodies. The data was fed into SPSS version 15 for descriptive analysis. RESULTS: In our study,28(56%) cases were male and 22(44%) were female. The age range was 1-7 years. Most of the victims (n=21; 42%) were over 3 years of age. Commonest symptom of presentation was dyspnoea (n=34; 68%) and the commonest sign of presentation was decreased unilateral air entry (n=25; 50%). Most of the foreign bodies were impacted in the right main bronchus (n=26; 52%). The most retrieved foreign body was betel nut (n=23; 46%). The commonest complication of bronchoscopy was airway oedema which occurred in 13 (26%) patients. The successful removal of exogenous foreign body was achieved in 41 (82%), and the mortality rate was 3 (6%). CONCLUSION: Delay in the diagnosis of foreign body inhalation translates into a higher risk of complications. Therefore, early bronchoscopy should be done on suspicion. Early recognition at both parental and clinical levels should be promoted through public awareness.

Fibrous dysplasia of mandible.

An elderly male presented to the ENT, Outpatient Department at Abbasi Shaheed Hospital (ASH) with a mass on the left side of the face and lower jaw for 8 - 9 years. It was of a tennis ball size. No treatment was sought by him during those years. A diagnosis of benign fibro-osseous lesion of the mandible was made. Later the histopathology proved the same. he first occurrence in a male gender and involvement of the mandible is uncommon.

Postembolization infarction in juvenile nasopharyngeal angiofibroma.

We report the occurrence of cerebro-vascular accident, following selective embolization of internal maxillary artery (IMA) in a young male patient aged 18 years admitted at ENT Department, Abbasi Shaheed Hospital (ASH) with diagnosis of recurrent juvenile nasophayrngeal angiofibroma (JNA). Angiography and selective trans-femoral embolization was done as an adjunctive measure before the definite surgical removal of this benign tumourous condition. The child developed weakness of the right half of body with slurred speech and drowsiness. CT scan of brain revealed the diagnosis of postembolization infarction. The patient recovered with no obvious signs of clinical residual weakness. Surgical excision after ligation of feeding vessel has been planned.

Follicular dendritic cell sarcoma of tonsil.

Follicular dendritic cell sarcoma is a very rare entity. So far only 12 cases have been reported world wide with involvement of tonsil. We present a new case of follicular dendritic cell sarcoma of the tonsil in a 52 years old woman with no evidence of neck node involvement. She had undergone diagnostic tonsillectomy due to unilateral tonsillar enlargement. The final diagnosis after histological review and immunohistochemical stains was follicular dendritic cell sarcoma. Bone scan showed no metastasis. One year follow-up after postoperative chemotherapy showed no evidence of local or regional recurrence. Follicular dendritic cell sarcoma is a rare and underdiagnosed neoplasm. It should be included in the differential diagnosis of any tonsillar mass in adults. Follicular dendritic cell markers such as SR-100, CD21 and/or CD35 are essential for the diagnosis.