A. K. Agarwal

Deep neck abscess: a prospective study of 54 cases

Deep neck abscesses (DNAs) continue to be commonly encountered in developing countries like India. This study was conducted to determine the changing trends within our population with respect to presentation, aetiology, location and microbiology of DNAs. Fifty-four patients with DNAs who were managed at the Department of ORL and H&N Surgery in our hospital between May 2002 and December 2002 formed the basis of the study. We observed that the high incidence of DNAs could be attributed to lack of awareness, illiteracy and poverty among patients, along with the poor primary health infrastructure. We also recommend early surgical intervention in these cases to decrease the prevalence of complications.

Study of Sphenoid Sinus Anatomy in Relation to Endoscopic Surgery

En las cirugias radicales del pasado, la definicion precisa de las hendiduras de los senos paranasales fueron de importancia limitada. En los ultimos anos, el abordaje transesfenoidal de la hipofisis y las relaciones del seno esfenoidal han tenido en la practica y en el estudio de la anatomia quirurgica, un significativo incremento. Para definir mejor esta anatomia, 20 senos esfenoidales fueron disecados en cadaveres para revelar importantes relaciones anatomicas, dimensiones, volumen y neumatizacion del seno esfenoidal. Los resultados de este estudio son discutidos con referencia particular para la anatomia quirurgica del seno esfenoidal. Los resultados tambien apuntan hacia la posibilidad de variaciones raciales, en terminos de relaciones del seno esfenoidal con la arteria carotida interna y el nervio optico, en la poblacion de la India

A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35,000 per month. Three thousand children between the ages of 5-12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.

Non-syndromic hearing impairment in India: high allelic heterogeneity among mutations in TMPRSS3, TMC1, USHIC, CDH23 and TMIE.

Mutations in the autosomal genes TMPRSS3, TMC1, USHIC, CDH23 and TMIE are known to cause hereditary hearing loss. To study the contribution of these genes to autosomal recessive, non-syndromic hearing loss (ARNSHL) in India, we examined 374 families with the disorder to identify potential mutations. We found four mutations in TMPRSS3, eight in TMC1, ten in USHIC, eight in CDH23 and three in TMIE. Of the 33 potentially pathogenic variants identified in these genes, 23 were new and the remaining have been previously reported. Collectively, mutations in these five genes contribute to about one-tenth of ARNSHL among the families examined. New mutations detected in this study extend the allelic heterogeneity of the genes and provide several additional variants for structure-function correlation studies. These findings have implications for early DNA-based detection of deafness and genetic counseling of affected families in the Indian subcontinent.

Primary tuberculosis of the tongue: a rare nodular presentation.

We report a case of a 38-year-old male who presented to us with a nodular swelling of the tongue with cervical lymphadenopathy suggestive of a malignancy. The lesion was diagnosed to be of tuberculous origin and the patient responded well to anti-tubercular chemotherapy.

Prevalence of preventable ear disorders in over 15,000 schoolchildren in northern India.

BACKGROUND There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India. METHOD A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry. RESULTS Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children. CONCLUSION Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture.

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

COCHLEAR IMPLANTATION IN INDIA: A PUBLIC HEALTH PERSPECTIVE

Around 7% of the population of India suffers from profound deafness. More than a million children needs either hearing aid or cochlear implant surgery to restore their hearing power. Many of them had never heard a single word since their birth. Still only 5000 cochlear implant surgery has been conducted in the country, the first being nearly 20 years ago, and most of them in private health facilities where the patient paid out of their pocket. The main reason of such poor penetration of the surgery in masses is the inhibitory cost associated with cochlear implant surgery and the lack of trained man-power to conduct such surgeries. The other reason is being the government engagement with other pressing health needs of the society resulting in the shout of ear care falling on deaf ears. With the advent of National Program for Prevention and Control of Deafness (NPPCD) in 2006, there is renewed interest in tackling this public health disaster.

Intraparotid facial nerve neurofibroma: an uncommon neoplasm

Los neurofibromas intraparotideos del nervio facial son una entidad poco frecuente, macroscopicamente e histopatologicamente diferentes de los comparativamente mas frecuentes schwannomas. Se presenta un caso raro de un neurofibroma del nervio facial con extension intraparotidea intratemporal en una mujer de 48 anos de edad. El tumor se extirpo quirurgicamente con injerto del nervio facial. La electroneurografia puede llegar a ayudar en el diagnostico preoperatorio. La reseccion del nervio facial debe ser realizada con mayor facilidad en un paciente con neurofibroma que en un paciente con schwannoma, sin embargo, la preservacion del nervio facial con electroneurografia de seguimiento y tomografia computarizada sigue siendo una opcion viable en pacientes con pequenos neurofibromas del nervio facial, cuando las pruebas electricas revelan minima evidencia de degeneracion neuronal progresiva. Una estrecha vigilancia, especialmente en los neurofibromas asociados con la enfermedad de Von Recklinghausen es fundamental debido al aumento del riesgo de degeneracion sarcomatosa.

Pneumatization of mastoid air cells: role of acquired factors

El mecanismo exacto de la neumatizacion del sistema de celulas mastoideas y los factores que influencian este proceso es pobremente comprendido. Factores geneticos, como tambien adquiridos, han sido implicados en el proceso de neumatizacion del sistema de celulas mastoideas. Esta neumatizacion es considerada un factor de importante pronostico en la conduccion de las cirugias reconstructivas de oido. Hemos llevado a cabo un estudio para explicar el rol de dos importantes factores adquiridos en la duracion de las otitis media cronica y el status funcional de la tuba auditiva en la neumatizacion de las celulas mastoideas. En 50 individuos, con otitis media cronica unilateral, se estudio su sistema de celulas aeriferas mastoideas usando la planimetria y las funciones de la tuba auditiva usando fluorescina, via nasofaringoscopia. Los resultados concuerdan con estudios previos, indicando una influencia definida de enfermedades cronicas del oido medio en el proceso de neumatizacion, aunque la duracion de la enfermedad no fue significativa. En contraste con los estudios previos, no se encontro influencia del status funcional de la tuba auditiva en la neumatizacion mastoidea