Clinical Study on Middle Ear Diseases in Children with Orofacial Clefts.

Introduction Orofacial clefts are associated with middle ear diseases, but the magnitude of this problem is not generally well appreciated. The aim of this study was to describe the middle ear findings and audiological profile in children with orofacial clefts. Materials and methods Children with orofacial clefts attending plastic surgery and otorhinolaryngology departments of a tertiary hospital over one-year duration were included in this study. Ninety-six children with orofacial clefts were identified. They were categorized age-wise as zero to five years, more than five years to 10 years, and more than 10 years to 15 years. They underwent a detailed ear, nose, and throat examination followed by audiological tests, including brainstem evoked response audiogram (BERA), pure tone audiogram (PTA), and tympanometry. Results Among 96 children with orofacial clefts, only 24 children (25%) had symptomatic ear problems, whereas on ear examination, 56 children (58.3%) had abnormal ear findings. Middle ear effusion (MEE) was the most common ear condition, and it was seen in 94 ears (48.9%). Cholesteatoma was noted in six children (3.1%). Out of 73 children in the zero to five age group, 58 children (79.5%) did not have any history of ear problem but 55.5% (81 ears) had features of MEE such as a dull tympanic membrane (TM). In the age group of more than five years to 10 years, only four children (28.5%) were symptomatic. Five children (55.5%) out of nine in the age group of more than 10 years had a symptomatic ear problem of which four children (44.4%) had chronic otitis media squamosal disease. The earlier age groups showed a trend of ear disease being asymptomatic compared to older children. Normal hearing was present in only 40 children (41.7%) and various degrees of hearing loss were seen in 56 children (58.3%). The mean air conduction threshold in the age group zero to five years, more than five years to 10 years, and more than 10 years were 33±8.3 decibels (dB), 25±6.2 dB, and 31.5±14 dB, respectively. Out of 144 ears (72 children) in the asymptomatic group, 67 ears (46.5%) had normal hearing. Seventy-seven ears (53.5%) had some degree of hearing loss. Mean air conduction hearing loss in the asymptomatic group was 29.8±7.3 dB. Conclusion This study highlights the higher incidence of middle ear diseases compared to the presenting symptoms in children with orofacial clefts. This stresses on the need for a detailed otological evaluation to identify any middle ear pathology so that timely intervention can be taken.

Congenital midnasal stenosis - A novel technique for management.

Neonates are obligate nasal breathers and nasal obstruction in a neonate is an emergency. Here we report two cases of congenital mid-nasal stenosis, discuss its presentation and diagnosis with description of a novel method of management.

Emergency ventilation with a Chevalier Jackson's metal tracheostomy tube.

Chevalier Jackson's metal tracheostomy tube is the oldest tracheostomy tube and has survived to the present day. This is probably because it is easy to use and cost-effective. However its biggest limitation is that it lacks provision to connect to a ventilating circuit in an emergency. Here we describe a simple and effective technique for ventilation with Chevalier Jackson's metal tracheostomy tube. Ventilation can be achieved by connecting the tracheostomy tube to an appropriate size universal 15mm endotracheal tube connector. We have also worked out a formula for selection of appropriate connector for various sizes of tracheostomy tube.

Dacryocystectomy: an uncommon indication--a case report.

Post traumatic nasolacrimal drainage obstruction is an uncommon presentation of naso-orbito-ethmoid fracture. Dacryocystorhinostomy (DCR) with or without silicon intubation is the universally accepted treatment modality. Here we report a case of recurrent lacrimal sac abscess due to post traumatic nasolacrimal drainage obstruction following naso-orbito-ethmoid fracture. The patient had previously undergone incision and drainage thrice and twice failed DCR. In the background of extensive nasal synechiae and twice failed DCR, dacryocystectomy was performed. Post operatively patient has improved and is symptom free for past 14 months. This is the first report of a successful dacryocystectomy for a post traumatic dacryocystitis.